Healthcare Provider Details

I. General information

NPI: 1508847690
Provider Name (Legal Business Name): PLASTIC SURGICAL CENTER OF MISSISSIPPI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 FLOWOOD DR STE 101
FLOWOOD MS
39232-9304
US

IV. Provider business mailing address

2550 FLOWOOD DR STE 101
FLOWOOD MS
39232-9304
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-5544
  • Fax: 601-939-8874
Mailing address:
  • Phone: 601-939-5544
  • Fax: 601-939-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMMY BURNETT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 601-939-9999