Healthcare Provider Details

I. General information

NPI: 1497849533
Provider Name (Legal Business Name): MIDSOUTH PATHOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LOWER WOODVILLE RD
NATCHEZ MS
39120
US

IV. Provider business mailing address

105 LOWER WOODVILLE RD
NATCHEZ MS
39120
US

V. Phone/Fax

Practice location:
  • Phone: 601-445-9585
  • Fax: 601-445-4185
Mailing address:
  • Phone: 601-445-9585
  • Fax: 601-445-4185

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: MRS. EVELYN H WHATLEY
Title or Position: MANAGER
Credential:
Phone: 601-445-9585