Healthcare Provider Details

I. General information

NPI: 1013656602
Provider Name (Legal Business Name): DIAGNOSTIC TISSUE/CYTOLOGY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 20TH AVE
MERIDIAN MS
39301-4124
US

IV. Provider business mailing address

PO BOX 3780
TUPELO MS
38803-3780
US

V. Phone/Fax

Practice location:
  • Phone: 601-483-8300
  • Fax: 601-484-7776
Mailing address:
  • Phone: 318-841-9500
  • Fax: 318-841-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN L WILKINSON
Title or Position: DIRECTOR
Credential: MD
Phone: 601-483-8300