Healthcare Provider Details

I. General information

NPI: 1265563779
Provider Name (Legal Business Name): CENTRAL MS. PLANNING & DEV. DISTRICT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 LAKELAND DR
JACKSON MS
39216-4701
US

IV. Provider business mailing address

PO BOX 4935
JACKSON MS
39296-4935
US

V. Phone/Fax

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

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 III
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 601-981-1511