Healthcare Provider Details

I. General information

NPI: 1609284330
Provider Name (Legal Business Name): TELEHEALTHONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRACE COLONY PARK DR STE C
RIDGELAND MS
39157-8812
US

IV. Provider business mailing address

200 TRACE COLONY PARK DR STE C
RIDGELAND MS
39157-8812
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-4342
  • Fax:
Mailing address:
  • Phone: 601-859-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM R MOON
Title or Position: CEO
Credential:
Phone: 601-859-4342