Healthcare Provider Details

I. General information

NPI: 1083340640
Provider Name (Legal Business Name): ANGELA C ROUNDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 CROWDER DR
CHARLESTON MS
38921-9825
US

IV. Provider business mailing address

1019 CROWDER DR
CHARLESTON MS
38921-9825
US

V. Phone/Fax

Practice location:
  • Phone: 662-607-9012
  • Fax:
Mailing address:
  • Phone: 662-607-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: