Healthcare Provider Details

I. General information

NPI: 1457322661
Provider Name (Legal Business Name): ENDOCRINE & METABOLIC DISORDERS INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 MARY VANCE DRIVE
TUPELO MS
38801-0000
US

IV. Provider business mailing address

910 MARY VANCE DRIVE
TUPELO MS
38801-0000
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-6275
  • Fax: 662-377-6299
Mailing address:
  • Phone: 662-377-6275
  • Fax: 662-377-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: JAYANT DEY
Title or Position: MD
Credential: MD
Phone: 662-377-6275