Healthcare Provider Details

I. General information

NPI: 1508959289
Provider Name (Legal Business Name): OXFORD PATHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 OFFICE PARK DRIVE
OXFORD MS
38655
US

IV. Provider business mailing address

1207 OFFICE PARK DRIVE
OXFORD MS
38655
US

V. Phone/Fax

Practice location:
  • Phone: 662-513-5753
  • Fax: 662-513-5747
Mailing address:
  • Phone: 662-513-5753
  • Fax: 662-513-5747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number11707
License Number StateMS

VIII. Authorized Official

Name: DR. LISA CHANDLER
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: M.D.
Phone: 662-513-5753