Healthcare Provider Details

I. General information

NPI: 1467161638
Provider Name (Legal Business Name): CARDIOLOGY ASSOCIATES OF NORTH MS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 5TH ST N
COLUMBUS MS
39705-2005
US

IV. Provider business mailing address

499 GLOSTER CREEK VLG STE A2
TUPELO MS
38801-4749
US

V. Phone/Fax

Practice location:
  • Phone: 662-327-3092
  • Fax:
Mailing address:
  • Phone: 662-620-6800
  • Fax: 662-620-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA LAMB
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 662-620-6800