Healthcare Provider Details

I. General information

NPI: 1538590104
Provider Name (Legal Business Name): OXFORDTMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 JACKSON AVE E
OXFORD MS
38655-3809
US

IV. Provider business mailing address

405 JACKSON AVE E
OXFORD MS
38655-3809
US

V. Phone/Fax

Practice location:
  • Phone: 662-236-5932
  • Fax:
Mailing address:
  • Phone: 662-236-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRISON EVANS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 662-236-5932