Healthcare Provider Details

I. General information

NPI: 1356531594
Provider Name (Legal Business Name): SOUTH MISSISSIPPI EMERGENCY PHYSICIANS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 01/22/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4891 HIGHWAY 589
SUMRALL MS
39482-4453
US

IV. Provider business mailing address

PO BOX 635614
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 601-758-4606
  • Fax: 601-758-4615
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN NELSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 601-288-2010