Healthcare Provider Details

I. General information

NPI: 1689861478
Provider Name (Legal Business Name): WADSWORTH CLINIC, P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 HIGHWAY 51 S
HERNANDO MS
38632-1737
US

IV. Provider business mailing address

2240 HIGHWAY 51 S
HERNANDO MS
38632-1737
US

V. Phone/Fax

Practice location:
  • Phone: 662-429-5231
  • Fax: 662-429-4922
Mailing address:
  • Phone: 662-429-5231
  • Fax: 662-429-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM M. WADSWORTH SR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 662-429-5231