Healthcare Provider Details

I. General information

NPI: 1053428060
Provider Name (Legal Business Name): NURAY METIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7676 SOUTHCREST PKWY
SOUTHHAVEN MS
38671
US

IV. Provider business mailing address

104 COURT ST
SENATOBIA MS
38668
US

V. Phone/Fax

Practice location:
  • Phone: 667-349-6577
  • Fax: 662-349-6562
Mailing address:
  • Phone: 662-562-4418
  • Fax: 662-562-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14759
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: