Healthcare Provider Details

I. General information

NPI: 1841761129
Provider Name (Legal Business Name): DCGM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER OAKS DR STE 302
FLOWOOD MS
39232-9575
US

IV. Provider business mailing address

PO BOX 321396
FLOWOOD MS
39232-1396
US

V. Phone/Fax

Practice location:
  • Phone: 601-613-4254
  • Fax:
Mailing address:
  • Phone: 601-613-4254
  • Fax: 601-939-9924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: LORI M YOUNG
Title or Position: NP
Credential: NP
Phone: 601-850-2170