Healthcare Provider Details

I. General information

NPI: 1699952325
Provider Name (Legal Business Name): MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

1225 N STATE STREET HOSPITALISTS PROGRAM 6TH FLOOR
JACKSON MS
39202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 601-292-4591
  • Fax: 601-974-6241
Mailing address:
  • Phone: 601-292-4591
  • Fax: 601-974-6241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH H MULLINS
Title or Position: PRESIDENT
Credential:
Phone: 601-292-4261