Healthcare Provider Details

I. General information

NPI: 1821152877
Provider Name (Legal Business Name): V A SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 HIGHWAY 80 W STE A
JACKSON MS
39209-5922
US

IV. Provider business mailing address

PO BOX 3183
RIDGELAND MS
39158-3183
US

V. Phone/Fax

Practice location:
  • Phone: 601-636-6019
  • Fax: 601-661-8457
Mailing address:
  • Phone: 601-636-6019
  • Fax: 601-661-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3192
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2019
License Number StateMS

VIII. Authorized Official

Name: MR. MARCUS T HARRIS
Title or Position: OWNER
Credential: PT
Phone: 601-927-7671