Healthcare Provider Details

I. General information

NPI: 1891951836
Provider Name (Legal Business Name): MISSISSIPPI ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR SUITE 750
JACKSON MS
39216-4643
US

IV. Provider business mailing address

971 LAKELAND DR SUITE 750
JACKSON MS
39216-4643
US

V. Phone/Fax

Practice location:
  • Phone: 601-987-3033
  • Fax: 601-987-9830
Mailing address:
  • Phone: 601-987-3033
  • Fax: 601-987-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL SEAGO
Title or Position: PARTNER
Credential: M.D.
Phone: 601-987-3033