Healthcare Provider Details

I. General information

NPI: 1073194163
Provider Name (Legal Business Name): TLS & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 HENRY HILL DR STE 200
JACKSON MS
39204-2013
US

IV. Provider business mailing address

2135 HENRY HILL DR STE 200
JACKSON MS
39204-2013
US

V. Phone/Fax

Practice location:
  • Phone: 601-942-7689
  • Fax:
Mailing address:
  • Phone: 601-942-7689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FREDERICK MARVIN TERRY
Title or Position: CEO
Credential:
Phone: 601-942-7689