Healthcare Provider Details

I. General information

NPI: 1053086819
Provider Name (Legal Business Name): DELTA HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 GETWELL DR
SENATOBIA MS
38668-2213
US

IV. Provider business mailing address

PO BOX 5247
GREENVILLE MS
38704-5247
US

V. Phone/Fax

Practice location:
  • Phone: 601-278-4104
  • Fax:
Mailing address:
  • Phone: 601-278-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA HAMMONS
Title or Position: CAO
Credential:
Phone: 601-278-4104