Healthcare Provider Details

I. General information

NPI: 1982717997
Provider Name (Legal Business Name): DEBORAH VIRGINIA GROSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 450
JACKSON MS
39202-2000
US

IV. Provider business mailing address

1000 URBAN CENTER DR STE 600
VESTAVIA AL
35242-2584
US

V. Phone/Fax

Practice location:
  • Phone: 601-957-7343
  • Fax:
Mailing address:
  • Phone: 205-208-9312
  • Fax: 208-848-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14099
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number14099
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: