Healthcare Provider Details

I. General information

NPI: 1154235166
Provider Name (Legal Business Name): GENISE J KNOX PCMHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E MAIN ST
LIBERTY MS
39645-7308
US

IV. Provider business mailing address

PO BOX 18679 4100 MAMIE STREET
HATTIESBURG MS
39404-8679
US

V. Phone/Fax

Practice location:
  • Phone: 769-667-0510
  • Fax:
Mailing address:
  • Phone: 601-705-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7299
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: