Healthcare Provider Details

I. General information

NPI: 1952991093
Provider Name (Legal Business Name): JAMES TURNER SANDERSON RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 COUNTY ROAD 505
CORINTH MS
38834-8323
US

IV. Provider business mailing address

401 ALCORN DR STE 2C
CORINTH MS
38834-9073
US

V. Phone/Fax

Practice location:
  • Phone: 662-317-8285
  • Fax:
Mailing address:
  • Phone: 662-293-7618
  • Fax: 662-293-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-1984
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: