Healthcare Provider Details

I. General information

NPI: 1366451049
Provider Name (Legal Business Name): TANYA JEAN FITTS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2166 S LAMAR BLVD
OXFORD MS
38655-5224
US

IV. Provider business mailing address

2166 S LAMAR BLVD
OXFORD MS
38655-5224
US

V. Phone/Fax

Practice location:
  • Phone: 662-236-3939
  • Fax: 662-236-3924
Mailing address:
  • Phone: 662-236-3939
  • Fax: 662-236-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17111
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: