Healthcare Provider Details

I. General information

NPI: 1871702035
Provider Name (Legal Business Name): POPLARVILLE SPECIAL SEPARATE MUNICIPAL SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W 11TH ST.
LUMBERTON MS
39455
US

IV. Provider business mailing address

804 S JULIA ST
POPLARVILLE MS
39470-3017
US

V. Phone/Fax

Practice location:
  • Phone: 601-796-8674
  • Fax: 601-796-2167
Mailing address:
  • Phone: 601-795-8477
  • Fax: 601-403-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR859077
License Number StateMS

VIII. Authorized Official

Name: MRS. LOUISE SMITH
Title or Position: SUPPORT STAFF SPECIALIST
Credential:
Phone: 601-795-8477