Healthcare Provider Details

I. General information

NPI: 1336656628
Provider Name (Legal Business Name): PATHWAY HEALTHCARE- COLUMBUS, MS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BLUECUTT RD STE 200
COLUMBUS MS
39705-1303
US

IV. Provider business mailing address

1000 URBAN CENTER DR STE 600
VESTAVIA AL
35242-2584
US

V. Phone/Fax

Practice location:
  • Phone: 844-728-4929
  • Fax:
Mailing address:
  • Phone: 205-208-9312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA COX
Title or Position: CREDENTIALING
Credential:
Phone: 205-208-9312