Healthcare Provider Details

I. General information

NPI: 1225143910
Provider Name (Legal Business Name): ALBERT MICHAEL KOURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL ST SUITE 100
JACKSON MS
39202-1651
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 601-969-7467
  • Fax: 601-948-1417
Mailing address:
  • Phone: 901-227-3255
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number09982
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: