Healthcare Provider Details

I. General information

NPI: 1083669121
Provider Name (Legal Business Name): PREMIER RADIOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CROSSOVER ROAD
TUPELO MS
38801
US

IV. Provider business mailing address

620 CROSSOVER RD
TUPELO MS
38801-4944
US

V. Phone/Fax

Practice location:
  • Phone: 662-620-7101
  • Fax:
Mailing address:
  • Phone: 662-842-1758
  • Fax: 662-844-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY CARLTON HOWARD
Title or Position: PRESIDENT
Credential: MD
Phone: 662-620-7102