Healthcare Provider Details

I. General information

NPI: 1730748443
Provider Name (Legal Business Name): YOSHITSUGU OBI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
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: 601-984-5608
  • Fax: 601-984-5608
Mailing address:
  • Phone: 601-984-5681
  • Fax: 601-984-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number75967
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number971-L
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: