Healthcare Provider Details

I. General information

NPI: 1053395111
Provider Name (Legal Business Name): FACES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 HIGHLAND COLONY PARKWAY SUITE G
RIDGELAND MS
39157
US

IV. Provider business mailing address

PO BOX 24023
JACKSON MS
39225-4023
US

V. Phone/Fax

Practice location:
  • Phone: 601-607-3033
  • Fax: 601-853-4939
Mailing address:
  • Phone: 601-366-1400
  • Fax: 601-366-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH HARRIS CARLIN
Title or Position: BOOKKEEPER
Credential:
Phone: 601-607-3033