Healthcare Provider Details

I. General information

NPI: 1518573575
Provider Name (Legal Business Name): SPECIALTY ORTHOPEDIC GROUP OF MS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 HIGHWAY 12 W
STARKVILLE MS
39759-3760
US

IV. Provider business mailing address

1211 S GLOSTER ST STE A
TUPELO MS
38801-6548
US

V. Phone/Fax

Practice location:
  • Phone: 662-767-4200
  • Fax: 662-767-4204
Mailing address:
  • Phone: 662-767-4200
  • Fax: 662-767-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNY MILLS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 662-767-4200