Healthcare Provider Details

I. General information

NPI: 1528443975
Provider Name (Legal Business Name): MEDICAL ASSURANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5903 RIDGEWOOD RD SUITE 320
JACKSON MS
39211-3700
US

IV. Provider business mailing address

5903 RIDGEWOOD RD SUITE 320
JACKSON MS
39211-3700
US

V. Phone/Fax

Practice location:
  • Phone: 601-899-3320
  • Fax: 601-899-3325
Mailing address:
  • Phone: 601-899-3320
  • Fax: 601-899-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HATTIE ARMSTRONG
Title or Position: CONTROLLER
Credential:
Phone: 601-899-3320