Healthcare Provider Details

I. General information

NPI: 1790806396
Provider Name (Legal Business Name): OXFORD BARIATRIC, GENERAL & METABOLIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 JEFFERSON DAVIS DR
OXFORD MS
38655-5221
US

IV. Provider business mailing address

2215 JEFFERSON DAVIS DR
OXFORD MS
38655-5221
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-3303
  • Fax: 662-232-8936
Mailing address:
  • Phone: 662-234-3303
  • Fax: 662-232-8936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICKI JOHNSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-234-3303