Healthcare Provider Details

I. General information

NPI: 1932908308
Provider Name (Legal Business Name): MIZE FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 HIGHWAY 28
MIZE MS
39116-5867
US

IV. Provider business mailing address

310 VIRGIL ST
TAYLORSVILLE MS
39168-5658
US

V. Phone/Fax

Practice location:
  • Phone: 615-524-0284
  • Fax:
Mailing address:
  • Phone: 615-524-0284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LELIA SIMPSON
Title or Position: MEMBER
Credential: FNP-C
Phone: 615-524-0284