Healthcare Provider Details

I. General information

NPI: 1649686395
Provider Name (Legal Business Name): MADISON MEDICAL RHEUMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 DOCTOR'S DRIVE
MADISON MS
39110-8671
US

IV. Provider business mailing address

507 RIDGE CIR
BRANDON MS
39047-8671
US

V. Phone/Fax

Practice location:
  • Phone: 769-300-2100
  • Fax: 601-790-9789
Mailing address:
  • Phone: 769-300-2100
  • Fax: 601-790-9789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT W. MCMURRY JR.
Title or Position: OWNER
Credential: MD
Phone: 601-321-9293