Healthcare Provider Details

I. General information

NPI: 1366544603
Provider Name (Legal Business Name): PARVEEN KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 RENAISSANCE WAY
RIDGELAND MS
39157-6038
US

IV. Provider business mailing address

PO BOX 2706
MADISON MS
39130-2706
US

V. Phone/Fax

Practice location:
  • Phone: 601-605-9914
  • Fax: 601-605-9904
Mailing address:
  • Phone: 601-605-9914
  • Fax: 601-605-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number15267
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number15267
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15267
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: