Healthcare Provider Details

I. General information

NPI: 1750671665
Provider Name (Legal Business Name): ANDERSON PHYSICIAN ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 OLD MILL CREEK ROAD
ENTERPRISE MS
39330-9649
US

IV. Provider business mailing address

2124 14TH ST
MERIDIAN MS
39301-4040
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-3465
  • Fax: 601-703-3408
Mailing address:
  • Phone: 601-553-6104
  • Fax: 601-553-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD J. HIGHTOWER
Title or Position: PRESIDENT
Credential:
Phone: 601-553-6104