Healthcare Provider Details

I. General information

NPI: 1316910755
Provider Name (Legal Business Name): ALEXANDER E OSOWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 N STATE ST
JACKSON MS
39206-5308
US

IV. Provider business mailing address

PO BOX 746085
ATLANTA GA
30374-6085
US

V. Phone/Fax

Practice location:
  • Phone: 601-533-7017
  • Fax:
Mailing address:
  • Phone: 469-727-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57551
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34412
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: