Healthcare Provider Details

I. General information

NPI: 1639295009
Provider Name (Legal Business Name): CENTRAL SURGICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N STATE ST SUITE 502
JACKSON MS
39202-2413
US

IV. Provider business mailing address

1190 N STATE ST STE 502
JACKSON MS
39202-2414
US

V. Phone/Fax

Practice location:
  • Phone: 601-944-1781
  • Fax: 601-353-0439
Mailing address:
  • Phone: 601-944-1781
  • Fax: 601-353-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LEE M NICOLS
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 601-944-1781