Healthcare Provider Details

I. General information

NPI: 1609508167
Provider Name (Legal Business Name): DANA EBB DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 GLOSTER CREEK VLG STE G1
TUPELO MS
38801-4751
US

IV. Provider business mailing address

499 GLOSTER CREEK VLG STE G1
TUPELO MS
38801-4751
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-2663
  • Fax: 662-377-6706
Mailing address:
  • Phone: 662-377-2663
  • Fax: 662-377-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDO4260
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO4260
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number34179
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: