Healthcare Provider Details

I. General information

NPI: 1043017452
Provider Name (Legal Business Name): PERSONIC MISSISSIPPI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E CAPITOL ST STE 200
JACKSON MS
39201-3405
US

IV. Provider business mailing address

PO BOX 8209
VIENNA VA
22183-2058
US

V. Phone/Fax

Practice location:
  • Phone: 251-901-3011
  • Fax:
Mailing address:
  • Phone: 251-901-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SYED NAQVI
Title or Position: OWNER
Credential:
Phone: 251-901-3011