Healthcare Provider Details

I. General information

NPI: 1558853077
Provider Name (Legal Business Name): SPECTRUM COMMUNITIES OF MISSISSIPPI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 TRACE COLONY PARK DR STE B
RIDGELAND MS
39157-8810
US

IV. Provider business mailing address

4525 FLAT SHOALS PKWY STE 401
DECATUR GA
30034-5038
US

V. Phone/Fax

Practice location:
  • Phone: 404-600-8675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: ERNEST FLAGG
Title or Position: CEO
Credential:
Phone: 404-600-8675