Healthcare Provider Details

I. General information

NPI: 1992237432
Provider Name (Legal Business Name): MEGHAN KOGER BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N MADISON ST
CORINTH MS
38834-5072
US

IV. Provider business mailing address

2703 SPRINGPORT RD
SARDIS MS
38666-3133
US

V. Phone/Fax

Practice location:
  • Phone: 662-286-9860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: