Healthcare Provider Details

I. General information

NPI: 1336338763
Provider Name (Legal Business Name): SOUTHERN HEALTHCARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NEW POINTE
RIDGELAND MS
39157-3904
US

IV. Provider business mailing address

301 NEW POINTE
RIDGELAND MS
39157-3904
US

V. Phone/Fax

Practice location:
  • Phone: 601-933-0037
  • Fax: 601-932-8468
Mailing address:
  • Phone: 601-933-0037
  • Fax: 601-932-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number27 17 009C
License Number StateMS

VIII. Authorized Official

Name: MS. JACKIE D. MCMILLAN
Title or Position: CEO
Credential:
Phone: 601-933-0037