Healthcare Provider Details

I. General information

NPI: 1568415560
Provider Name (Legal Business Name): MISSISSIPPI SPORTS MEDICINE & ORTHOPAEDIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E FORTIFICATION ST
JACKSON MS
39202-2442
US

IV. Provider business mailing address

1325 E FORTIFICATION ST
JACKSON MS
39202-2442
US

V. Phone/Fax

Practice location:
  • Phone: 601-949-9106
  • Fax: 601-351-5980
Mailing address:
  • Phone: 601-354-4488
  • Fax: 601-351-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MEREDITH GORE WARF
Title or Position: CEO
Credential:
Phone: 601-605-5393