Healthcare Provider Details

I. General information

NPI: 1972189330
Provider Name (Legal Business Name): RELIAS HOSPITALIST MEDICINE SPECIALISTS OF PONTOTOC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 S MAIN ST
PONTOTOC MS
38863-3311
US

IV. Provider business mailing address

PO BOX 32095
CHARLOTTE NC
28232-2095
US

V. Phone/Fax

Practice location:
  • Phone: 662-489-5510
  • Fax:
Mailing address:
  • Phone: 662-432-4106
  • Fax: 781-276-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER KATHRYN WAKEFORD
Title or Position: ENTERPRISE CFO
Credential:
Phone: 205-901-5103