Healthcare Provider Details

I. General information

NPI: 1801916481
Provider Name (Legal Business Name): CHILDREN'S CLINIC OF OXFORD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 S LAMAR BLVD
OXFORD MS
38655-5347
US

IV. Provider business mailing address

2888 S LAMAR BLVD
OXFORD MS
38655-5347
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-8286
  • Fax: 662-234-6644
Mailing address:
  • Phone: 662-234-8286
  • Fax: 662-234-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10280
License Number StateMS

VIII. Authorized Official

Name: JOE TANNER HARRIS
Title or Position: OWNER
Credential: M.D.
Phone: 662-234-8286