Healthcare Provider Details

I. General information

NPI: 1972415412
Provider Name (Legal Business Name): MELISSA RATLIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COLEMAN RD
JAYESS MS
39641-8345
US

IV. Provider business mailing address

5 COLEMAN RD
JAYESS MS
39641-8345
US

V. Phone/Fax

Practice location:
  • Phone: 601-522-4054
  • Fax:
Mailing address:
  • Phone: 601-522-4054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: