Healthcare Provider Details

I. General information

NPI: 1679634638
Provider Name (Legal Business Name): OXFORD PEDIATRIC GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 MEDICAL PARK DR
OXFORD MS
38655-5327
US

IV. Provider business mailing address

1203 MEDICAL PARK DR
OXFORD MS
38655-5327
US

V. Phone/Fax

Practice location:
  • Phone: 662-513-4399
  • Fax: 662-513-4330
Mailing address:
  • Phone: 662-513-4399
  • Fax: 662-513-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAM I MARRIAM
Title or Position: OFFICE MANAGER
Credential: CPA
Phone: 662-513-4399