Healthcare Provider Details

I. General information

NPI: 1285126227
Provider Name (Legal Business Name): MEDPLUS FULTON , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 INTERCHANGE DRIVE
FULTON MS
38843
US

IV. Provider business mailing address

874 BARNES CROSSING RD
TUPELO MS
38804-0909
US

V. Phone/Fax

Practice location:
  • Phone: 662-841-0002
  • Fax: 662-269-6346
Mailing address:
  • Phone: 662-841-0002
  • Fax: 662-269-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOHN LOGAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 662-841-0002