Healthcare Provider Details

I. General information

NPI: 1982821310
Provider Name (Legal Business Name): DENISE E PHILLIPS,MD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 LAKELAND DR STE 400
JACKSON MS
39204
US

IV. Provider business mailing address

764 LAKELAND DR STE 400
JACKSON MS
39204
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-1550
  • Fax: 601-981-0804
Mailing address:
  • Phone: 601-981-1550
  • Fax: 601-981-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13171
License Number StateMS

VIII. Authorized Official

Name: DR. DENISE E PHILLIPS
Title or Position: PRESIDENT
Credential: MD
Phone: 601-981-7991