Healthcare Provider Details

I. General information

NPI: 1275495947
Provider Name (Legal Business Name): CHARLES BORUM M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 JEFFERSON DAVIS BLVD STE F
NATCHEZ MS
39120-5143
US

IV. Provider business mailing address

131 JEFFERSON DAVIS BLVD STE F
NATCHEZ MS
39120-5143
US

V. Phone/Fax

Practice location:
  • Phone: 601-442-0200
  • Fax: 601-445-0210
Mailing address:
  • Phone: 601-442-0200
  • Fax: 601-445-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MCLEMORE
Title or Position: CLINIC MANAGER
Credential:
Phone: 601-422-5223