Healthcare Provider Details

I. General information

NPI: 1356539118
Provider Name (Legal Business Name): HIGHLAND PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CARROLL ST
PICAYUNE MS
39466-2607
US

IV. Provider business mailing address

409 CARROLL ST
PICAYUNE MS
39466-2607
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-5227
  • Fax: 601-798-5271
Mailing address:
  • Phone: 601-798-5227
  • Fax: 601-798-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE A RODRIGUEZ
Title or Position: OWNER
Credential: MD
Phone: 601-798-5227