Healthcare Provider Details

I. General information

NPI: 1275737959
Provider Name (Legal Business Name): HERZOG & HERZOG, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FORTY FIVE HUNDRED INTERSTATE FIFTY FIVE NORTH 208 HIGHLAND VILLAGE
JACKSON MS
39211
US

IV. Provider business mailing address

FORTY-FIVE HUNDRED INTERSATE FIFTY FIVE NORTH 208 HIGHLAND VILLAGE
JACKSON MS
39211
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-5757
  • Fax: 601-981-5494
Mailing address:
  • Phone: 601-981-5757
  • Fax: 601-981-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26348
License Number StateMS

VIII. Authorized Official

Name: MR. JAMES D. HERZOG
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 601-981-5757