Healthcare Provider Details

I. General information

NPI: 1295224954
Provider Name (Legal Business Name): FLORA PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 MAIN ST
FLORA MS
39071-9515
US

IV. Provider business mailing address

PO BOX D
FLORA MS
39071-1004
US

V. Phone/Fax

Practice location:
  • Phone: 769-300-1775
  • Fax:
Mailing address:
  • Phone: 769-300-1775
  • Fax: 769-300-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICAH R WALKER
Title or Position: MEMBER
Credential: MD
Phone: 662-402-1219