Healthcare Provider Details

I. General information

NPI: 1306502943
Provider Name (Legal Business Name): MISSISSIPPI PEDIATRIC ENDOCRINE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 W BANKHEAD ST
NEW ALBANY MS
38652-3319
US

IV. Provider business mailing address

1600 N STATE ST STE 400
JACKSON MS
39202-1689
US

V. Phone/Fax

Practice location:
  • Phone: 601-944-1717
  • Fax:
Mailing address:
  • Phone: 601-944-1717
  • Fax: 601-944-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA A SILVER
Title or Position: OWNER
Credential: DO
Phone: 662-432-0961