Healthcare Provider Details

I. General information

NPI: 1619088838
Provider Name (Legal Business Name): CANTONS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1883 HIGHWAY 43 SOUTH SUITE D
CANTON MS
39046
US

IV. Provider business mailing address

1883 HIGHWAY 43 SOUTH SUITE D
CANTON MS
39046
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-8992
  • Fax: 601-855-5265
Mailing address:
  • Phone: 601-859-8992
  • Fax: 601-855-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEBBIE VOGT
Title or Position: MEDICAL PRACTICE MANAGER
Credential:
Phone: 601-859-8992