Healthcare Provider Details

I. General information

NPI: 1497687677
Provider Name (Legal Business Name): JAMIE TAYLOR REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 DEES DR STE M
GLUCKSTADT MS
39110-5057
US

IV. Provider business mailing address

102 DEES DR STE M
GLUCKSTADT MS
39110-5057
US

V. Phone/Fax

Practice location:
  • Phone: 601-381-8200
  • Fax:
Mailing address:
  • Phone: 601-381-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112666
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: