Healthcare Provider Details

I. General information

NPI: 1477817526
Provider Name (Legal Business Name): OXFORD CENTRE PHYSICIAN GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 UNIVERSITY AVE
OXFORD MS
38655-4114
US

IV. Provider business mailing address

PO BOX 3488 DEPT. 05-022
TUPELO MS
38803-3488
US

V. Phone/Fax

Practice location:
  • Phone: 662-281-9992
  • Fax: 662-281-1326
Mailing address:
  • Phone: 662-281-9992
  • Fax: 662-281-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS DEBOW FOWLKES
Title or Position: PRESIDENT
Credential: MD
Phone: 662-281-9992