Healthcare Provider Details

I. General information

NPI: 1497864169
Provider Name (Legal Business Name): NOBEL DZORGBENYAH ATTIPOE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. DZORGBENYAH NOBEL ATTIPOE

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 W. NORTHSIDE DRIVE
JACKSON MS
39213
US

IV. Provider business mailing address

3502 W. NORTHSIDE DRIVE
JACKSON MS
39213
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number226843
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number19183
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: