Healthcare Provider Details

I. General information

NPI: 1295193589
Provider Name (Legal Business Name): SOUTHERN GRACE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N MAIN ST STE 200
PETAL MS
39465-2366
US

IV. Provider business mailing address

117 N MAIN ST STE 200
PETAL MS
39465-2366
US

V. Phone/Fax

Practice location:
  • Phone: 601-602-5411
  • Fax: 601-602-5410
Mailing address:
  • Phone: 601-602-5411
  • Fax: 601-602-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: GREGORY SHAWN ELKINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-602-5411