Healthcare Provider Details

I. General information

NPI: 1932587979
Provider Name (Legal Business Name): OSMAN ATHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CANEBRAKE BLVD
FLOWOOD MS
39232-2211
US

IV. Provider business mailing address

10 CANEBRAKE BLVD STE 110
FLOWOOD MS
39232-2212
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27899
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: