Healthcare Provider Details

I. General information

NPI: 1750336574
Provider Name (Legal Business Name): MISSISSIPPI INPATIENT MEDICINE ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 AVENT DR
GRENADA MS
38901-5045
US

IV. Provider business mailing address

PO BOX 52007
ATLANTA GA
30355-0007
US

V. Phone/Fax

Practice location:
  • Phone: 662-227-6426
  • Fax: 662-227-7541
Mailing address:
  • Phone: 678-441-8500
  • Fax: 678-397-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TALBOT G MCCORMICK III
Title or Position: PRESIDENT
Credential: MD
Phone: 678-441-8500