Healthcare Provider Details

I. General information

NPI: 1902591951
Provider Name (Legal Business Name): OLIVIA AUGUSTA BECKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-4124
  • Fax: 601-984-4119
Mailing address:
  • Phone: 601-984-1000
  • Fax: 601-984-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberT-6237
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: