Healthcare Provider Details

I. General information

NPI: 1851948244
Provider Name (Legal Business Name): HEALTH HEROES OF MISSISSIPPI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 06/10/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 AVERY BLVD N
RIDGELAND MS
39157-5219
US

IV. Provider business mailing address

326 PRAIRIE STREET NORTH
UNION SPRINGS AL
36089-1417
US

V. Phone/Fax

Practice location:
  • Phone: 205-609-0268
  • Fax: 866-737-9625
Mailing address:
  • Phone: 205-609-0268
  • Fax: 866-737-9625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LIBERTY DUKE
Title or Position: PRESIDENT
Credential:
Phone: 334-220-2484