Healthcare Provider Details

I. General information

NPI: 1871207456
Provider Name (Legal Business Name): INTERNAL MEDICINE AND PEDIATRIC CLINIC OF NEW ALBANY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CITY MARKET DR
SALTILLO MS
38866-7002
US

IV. Provider business mailing address

118 FAIRFIELD DR
NEW ALBANY MS
38652-3107
US

V. Phone/Fax

Practice location:
  • Phone: 662-534-0898
  • Fax: 662-534-8905
Mailing address:
  • Phone: 662-534-0898
  • Fax: 662-534-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RACHEL MARIE THOMAS
Title or Position: BILLING MANAGER/CREDENTIALING
Credential: CPC
Phone: 662-534-0898