Healthcare Provider Details

I. General information

NPI: 1013115088
Provider Name (Legal Business Name): ASHLEY MILLER CANIZARO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 RIVER OAKS DRIVE SUITE 310
JACKSON MS
39232
US

IV. Provider business mailing address

1020 RIVER OAKS DRIVE SUITE 310
JACKSON MS
39232
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-5006
  • Fax: 601-932-4548
Mailing address:
  • Phone: 601-932-5006
  • Fax: 601-932-4548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number21528
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: