Healthcare Provider Details

I. General information

NPI: 1942104062
Provider Name (Legal Business Name): PRICE CONERLY CHADWICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER OAKS DR STE 202
FLOWOOD MS
39232-9534
US

IV. Provider business mailing address

1 BEACON HILL RD
MADISON MS
39110-9109
US

V. Phone/Fax

Practice location:
  • Phone: 601-353-9900
  • Fax:
Mailing address:
  • Phone: 601-672-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: