Healthcare Provider Details

I. General information

NPI: 1679562094
Provider Name (Legal Business Name): MICHAEL HOLGER ALBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 CENTER ST STE B
RICHLAND MS
39218-4800
US

IV. Provider business mailing address

129 CENTER ST STE B
RICHLAND MS
39218-4800
US

V. Phone/Fax

Practice location:
  • Phone: 692-337-1417
  • Fax: 769-233-7726
Mailing address:
  • Phone: 769-233-7141
  • Fax: 769-233-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10754
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: