Healthcare Provider Details

I. General information

NPI: 1043581614
Provider Name (Legal Business Name): CENTRAL MS PLANNING & DEVELPMENT DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 LAKELAND DR
JACKSON MS
39216-4701
US

IV. Provider business mailing address

1170 LAKELAND DR
JACKSON MS
39216-4701
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-1511
  • Fax: 601-981-1515
Mailing address:
  • Phone: 601-981-1511
  • Fax: 601-981-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0770316
License Number StateMS

VIII. Authorized Official

Name: MR. F CLARKE HOLMES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 601-981-1511