Healthcare Provider Details

I. General information

NPI: 1538436167
Provider Name (Legal Business Name): MID-SOUTH NEUROLOGY-SLEEP MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 PROPER ST
CORINTH MS
38834-5394
US

IV. Provider business mailing address

2425 PROPER ST
CORINTH MS
38834-5394
US

V. Phone/Fax

Practice location:
  • Phone: 662-396-9447
  • Fax: 662-396-9449
Mailing address:
  • Phone: 662-396-9447
  • Fax: 662-396-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number18354
License Number StateMS

VIII. Authorized Official

Name: MRS. ASHLEY TAYLOR
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 662-396-9447