Healthcare Provider Details

I. General information

NPI: 1063507549
Provider Name (Legal Business Name): SOUTHERN PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 RIVER OAKS DRIVE STE 450
JACKSON MS
39232
US

IV. Provider business mailing address

1020 RIVER OAKS DRIVE STE 450
JACKSON MS
39232
US

V. Phone/Fax

Practice location:
  • Phone: 601-420-1930
  • Fax: 601-420-1931
Mailing address:
  • Phone: 601-420-1930
  • Fax: 601-420-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: RAHUL VOHRA
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 601-420-1930