Healthcare Provider Details

I. General information

NPI: 1205635034
Provider Name (Legal Business Name): ALICE MCCRANEY WEGENER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N STATE ST
JACKSON MS
39201-1906
US

IV. Provider business mailing address

701 GROVE RD ORTHOPEDIC RESIDENCY
GREENVILLE SC
29605-4210
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5012
  • Fax:
Mailing address:
  • Phone: 864-455-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberLL97054
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: