Healthcare Provider Details

I. General information

NPI: 1780303446
Provider Name (Legal Business Name): GI ALLIANCE ANESTHESIA OF MISSISSIPPI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 LAKELAND DR
FLOWOOD MS
39232-9513
US

IV. Provider business mailing address

PO BOX 201435
DALLAS TX
75320-1435
US

V. Phone/Fax

Practice location:
  • Phone: 601-355-1234
  • Fax:
Mailing address:
  • Phone: 817-402-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN WILEY
Title or Position: VP ANESTHESIA SERVICES
Credential: CRNA
Phone: 817-774-7197