Healthcare Provider Details

I. General information

NPI: 1154916872
Provider Name (Legal Business Name): MEDPLUS NEW ALBANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PARK PLAZA DR
NEW ALBANY MS
38652-3127
US

IV. Provider business mailing address

874 BARNES CROSSING RD
TUPELO MS
38804-0909
US

V. Phone/Fax

Practice location:
  • Phone: 662-222-2219
  • Fax: 662-510-0216
Mailing address:
  • Phone: 662-841-0002
  • Fax: 662-269-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMANTHA LOGAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 662-222-2273