Healthcare Provider Details

I. General information

NPI: 1821678160
Provider Name (Legal Business Name): MARY MORGAN ALFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST # S139-01
JACKSON MS
39216-4500
US

IV. Provider business mailing address

150 PARK CIRCLE DR APT E52
FLOWOOD MS
39232-7633
US

V. Phone/Fax

Practice location:
  • Phone: 848-960-1815
  • Fax:
Mailing address:
  • Phone: 601-832-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1821678160
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: