Healthcare Provider Details

I. General information

NPI: 1124756465
Provider Name (Legal Business Name): MONIQUE GILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N STATE ST
JACKSON MS
39202-2627
US

IV. Provider business mailing address

7793 DAVIS PKWY
SOUTHAVEN MS
38671-6217
US

V. Phone/Fax

Practice location:
  • Phone: 662-553-6382
  • Fax:
Mailing address:
  • Phone: 662-360-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC12111
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9839
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: