Healthcare Provider Details

I. General information

NPI: 1487355608
Provider Name (Legal Business Name): NORTH MISSISSIPPI CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
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: 662-324-2091
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: WENDY CHISHOLM
Title or Position: CEO
Credential:
Phone: 662-620-6800