Healthcare Provider Details

I. General information

NPI: 1699288829
Provider Name (Legal Business Name): ENVISION CHILDREN'S HEALTHCARE SERVICES OF NORTH MISSISSIPPI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S LAMAR BLVD
OXFORD MS
38655-5373
US

IV. Provider business mailing address

2301 S LAMAR BLVD
OXFORD MS
38655-5373
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GILBERT DROZDOW
Title or Position: SVP
Credential:
Phone: 954-939-5000