Healthcare Provider Details

I. General information

NPI: 1538358288
Provider Name (Legal Business Name): CASSADA PSYCHIATRIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S DEER CREEK DR W
LELAND MS
38756-3130
US

IV. Provider business mailing address

PO BOX 939
LELAND MS
38756-0939
US

V. Phone/Fax

Practice location:
  • Phone: 662-820-6899
  • Fax:
Mailing address:
  • Phone: 662-820-6899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16112
License Number StateMS

VIII. Authorized Official

Name: DR. MARGARET KEA OGDEN CASSADA
Title or Position: PRESIDENT CEO
Credential: M.D.
Phone: 662-820-6899