Healthcare Provider Details

I. General information

NPI: 1215933346
Provider Name (Legal Business Name): HEEERS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 HOSPITAL DR
JACKSON MS
39204-3410
US

IV. Provider business mailing address

1814 HOSPITAL DR
JACKSON MS
39204-3410
US

V. Phone/Fax

Practice location:
  • Phone: 601-373-2940
  • Fax: 601-373-2720
Mailing address:
  • Phone: 601-373-2940
  • Fax: 601-373-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number13888
License Number StateMS

VIII. Authorized Official

Name: DR. HURSIE J DAVIS-SULLIVAN
Title or Position: OWNER AND PRESIDENT
Credential: M.D.
Phone: 601-373-2940