Healthcare Provider Details

I. General information

NPI: 1124584800
Provider Name (Legal Business Name): TEESSA PEREKATTU KURUVILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF RADIATION ONCOLOGY 350 WOODROW WILSON DR
JACKSON MS
39216-4505
US

IV. Provider business mailing address

UNIVERSITY OF MS MEDICAL CENTER 2500 N STATE ST DEPARTMENT OF RADIATION ONCOLOGY
JACKSON MS
39216-4505
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-6886
  • Fax: 601-815-1846
Mailing address:
  • Phone: 601-815-6886
  • Fax: 601-815-1846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberT-3726
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01095903A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: