Healthcare Provider Details

I. General information

NPI: 1932180635
Provider Name (Legal Business Name): ANTHONY LANE ARMSTRONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ALCORN DR SUITE 1E
CORINTH MS
38834-9072
US

IV. Provider business mailing address

PO BOX 24023
JACKSON MS
39225-4023
US

V. Phone/Fax

Practice location:
  • Phone: 662-665-0457
  • Fax: 662-665-0458
Mailing address:
  • Phone: 662-665-0457
  • Fax: 662-665-0458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14758
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: