Healthcare Provider Details

I. General information

NPI: 1801933494
Provider Name (Legal Business Name): DAVID MICHAEL PRYCE-JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CONSTITUTION DR
IUKA MS
38852-8201
US

IV. Provider business mailing address

503 CONSTITUTION DR
IUKA MS
38852-8201
US

V. Phone/Fax

Practice location:
  • Phone: 662-424-9500
  • Fax: 662-424-9592
Mailing address:
  • Phone: 662-424-9500
  • Fax: 662-424-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT1834
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: