Healthcare Provider Details

I. General information

NPI: 1164630349
Provider Name (Legal Business Name): KESHA MAJOR FLANTROY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 W NORTHSIDE DR
JACKSON MS
39213-4454
US

IV. Provider business mailing address

3502 W NORTHSIDE DRIVE
JACKSON MS
39213
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-5321
  • Fax: 601-364-5159
Mailing address:
  • Phone: 601-362-5321
  • Fax: 601-362-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME96498
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberME96498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: