Healthcare Provider Details

I. General information

NPI: 1134249253
Provider Name (Legal Business Name): MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7275 S SIWELL RD
JACKSON MS
39272-9776
US

IV. Provider business mailing address

7275 S SIWELL RD
JACKSON MS
39272-9776
US

V. Phone/Fax

Practice location:
  • Phone: 601-373-7722
  • Fax: 601-373-7378
Mailing address:
  • Phone: 601-373-7722
  • Fax: 601-373-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH H MULLINS
Title or Position: DIRECTOR OF CLINIC ADMINISTRATION
Credential:
Phone: 601-292-4261