Healthcare Provider Details

I. General information

NPI: 1710553052
Provider Name (Legal Business Name): MCAFEE SAFETY ANALYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 NORTHPARK DR STE 200
RIDGELAND MS
39157-5223
US

IV. Provider business mailing address

875 NORTHPARK DR STE 200
RIDGELAND MS
39157-5223
US

V. Phone/Fax

Practice location:
  • Phone: 601-812-6252
  • Fax:
Mailing address:
  • Phone: 601-812-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT DANIEL BRIDGEWATER
Title or Position: OFFICE ADMINSTRATOR
Credential:
Phone: 601-812-6252