Healthcare Provider Details

I. General information

NPI: 1649238882
Provider Name (Legal Business Name): MS PATHOLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

PO BOX 2153 DEPT. 1950
BIRMINGHAM AL
35287
US

V. Phone/Fax

Practice location:
  • Phone: 601-968-3070
  • Fax: 601-974-6286
Mailing address:
  • Phone: 601-944-1717
  • Fax: 601-944-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateMS

VIII. Authorized Official

Name: DR. JAMES CAVETT
Title or Position: LAB
Credential: M.D
Phone: 601-968-3070