Healthcare Provider Details

I. General information

NPI: 1710676952
Provider Name (Legal Business Name): FRANCIS AGAMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 SOUTHCREST PKWY
SOUTHAVEN MS
38671-4742
US

IV. Provider business mailing address

385 NAIL RD APT C34
SOUTHAVEN MS
38671-7276
US

V. Phone/Fax

Practice location:
  • Phone: 662-772-4696
  • Fax:
Mailing address:
  • Phone: 850-901-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number77704
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: