Healthcare Provider Details

I. General information

NPI: 1720922453
Provider Name (Legal Business Name): TIMOTHY DOWNS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 SHANNON LN
LUCEDALE MS
39452-9563
US

IV. Provider business mailing address

119 SHANNON LN
LUCEDALE MS
39452-9563
US

V. Phone/Fax

Practice location:
  • Phone: 228-234-4595
  • Fax:
Mailing address:
  • Phone: 228-234-4595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number87-2227785
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: