Healthcare Provider Details

I. General information

NPI: 1851305700
Provider Name (Legal Business Name): METROPOLITAN UROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 360
JACKSON MS
39216-4607
US

IV. Provider business mailing address

971 LAKELAND DR STE 360
JACKSON MS
39216-4607
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-0982
  • Fax: 601-366-9927
Mailing address:
  • Phone: 601-982-0982
  • Fax: 601-366-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RENETTA KINDS TAYLOR
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-982-0982