Healthcare Provider Details

I. General information

NPI: 1982913125
Provider Name (Legal Business Name): NATCHEZ MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 SGT PRENTISS DR
NATCHEZ MS
39120-4792
US

IV. Provider business mailing address

46 SGT PRENTISS DR
NATCHEZ MS
39120-4792
US

V. Phone/Fax

Practice location:
  • Phone: 866-914-6361
  • Fax: 225-644-6368
Mailing address:
  • Phone: 866-914-6361
  • Fax: 225-644-6368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUREN H BRADY
Title or Position: BILLING MANAGER
Credential: CPC
Phone: 866-914-6361