Healthcare Provider Details

I. General information

NPI: 1982902797
Provider Name (Legal Business Name): DRA HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 WOODLAND BROOK DR
MADISON MS
39110
US

IV. Provider business mailing address

248 WOODLAND BROOK DR
MADISON MS
39110
US

V. Phone/Fax

Practice location:
  • Phone: 601-955-5008
  • Fax:
Mailing address:
  • Phone: 601-955-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateMS

VIII. Authorized Official

Name: MR. TONY L GINES
Title or Position: OWNER
Credential: TERRITORY MANAGER
Phone: 601-955-5008