Healthcare Provider Details

I. General information

NPI: 1164666251
Provider Name (Legal Business Name): AHP OF SOUTHAVEN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9140 HIGHWAY 51 N
SOUTHAVEN MS
38671-1233
US

IV. Provider business mailing address

2727 PACES FERRY RD SE BUILDING 2 SUITE 400
ATLANTA GA
30339-4053
US

V. Phone/Fax

Practice location:
  • Phone: 662-280-8222
  • Fax: 662-280-5541
Mailing address:
  • Phone: 678-223-7726
  • Fax: 678-388-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ULRIC DUNCAN
Title or Position: OWNER
Credential: MD
Phone: 662-280-8222