Healthcare Provider Details

I. General information

NPI: 1649716523
Provider Name (Legal Business Name): DR. TODD FINCHER P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E MARKET ST
GREENWOOD MS
38930-4429
US

IV. Provider business mailing address

PO BOX 1531
GREENWOOD MS
38935-1531
US

V. Phone/Fax

Practice location:
  • Phone: 662-453-1708
  • Fax:
Mailing address:
  • Phone: 662-453-1708
  • Fax: 662-453-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number227286
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD FINCHER
Title or Position: OWNER
Credential:
Phone: 662-453-1708