Healthcare Provider Details

I. General information

NPI: 1881516128
Provider Name (Legal Business Name): JAMES DALE SKAGGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HARVEST CIR
PETAL MS
39465-6826
US

IV. Provider business mailing address

60 HARVEST CIR
PETAL MS
39465-6826
US

V. Phone/Fax

Practice location:
  • Phone: 601-335-5337
  • Fax:
Mailing address:
  • Phone: 601-335-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP060360A
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8251
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: