Healthcare Provider Details

I. General information

NPI: 1619175072
Provider Name (Legal Business Name): GREG SNYDER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SOUTH LAMAR BLVD SUITE 1200
OXFORD MS
38655
US

IV. Provider business mailing address

PO BOX 1848
UNIVERSITY MS
38677
US

V. Phone/Fax

Practice location:
  • Phone: 662-915-7271
  • Fax: 662-915-7263
Mailing address:
  • Phone: 662-915-7271
  • Fax: 662-915-7263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12032376
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: