Healthcare Provider Details

I. General information

NPI: 1285728576
Provider Name (Legal Business Name): MARY LEE MCALEXANDER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMC 1500 E. WOODROW WILSON AUDIOLOGY SERVICE
JACKSON MS
39216
US

IV. Provider business mailing address

464 MAGNOLIA PLACE
BRANDON MS
39042
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax: 601-368-4140
Mailing address:
  • Phone: 601-824-6031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA0683
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: