Healthcare Provider Details

I. General information

NPI: 1083786727
Provider Name (Legal Business Name): CARY N METTETAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E LEE ST
SARDIS MS
38666-1227
US

IV. Provider business mailing address

401 E LEE ST
SARDIS MS
38666-1227
US

V. Phone/Fax

Practice location:
  • Phone: 662-487-0004
  • Fax: 662-487-0006
Mailing address:
  • Phone: 662-487-0004
  • Fax: 662-487-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMS

VIII. Authorized Official

Name: PENNY HARRISON
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-487-0004