Healthcare Provider Details

I. General information

NPI: 1184165102
Provider Name (Legal Business Name): SINUS AND ALLERGY INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 HIGHLAND COLONY PARKWAY SUITE C
RIDGELAND MS
39157
US

IV. Provider business mailing address

PO BOX 3114
RIDGELAND MS
39158-3114
US

V. Phone/Fax

Practice location:
  • Phone: 662-769-5006
  • Fax:
Mailing address:
  • Phone: 662-769-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number18626
License Number StateMS

VIII. Authorized Official

Name: JENNIFER R DAVIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-769-5006