Healthcare Provider Details

I. General information

NPI: 1992008429
Provider Name (Legal Business Name): DELORA A. DENNEY, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2010
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MEDICAL PLAZA BLVD SUITE B
PICAYUNE MS
39466-9197
US

IV. Provider business mailing address

12 MEDICAL PLAZA BLVD SUITE B
PICAYUNE MS
39466-9197
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-5281
  • Fax: 601-799-5778
Mailing address:
  • Phone: 601-798-5281
  • Fax: 601-799-5778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13824
License Number StateMS

VIII. Authorized Official

Name: DR. DELORA ANN DENNEY
Title or Position: PARTNER, CO-OWNER
Credential: MD
Phone: 601-798-5281