Healthcare Provider Details

I. General information

NPI: 1346104411
Provider Name (Legal Business Name): JOSEPH PERRY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 JACKSON COUNTY LINE RD
LUCEDALE MS
39452-4003
US

IV. Provider business mailing address

7725 JACKSON COUNTY LINE RD
LUCEDALE MS
39452-4003
US

V. Phone/Fax

Practice location:
  • Phone: 228-369-2750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: