Healthcare Provider Details

I. General information

NPI: 1629049846
Provider Name (Legal Business Name): TERRY WESLEY PINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4381 S EASON BLVD SUITE 202
TUPELO MS
38801-6583
US

IV. Provider business mailing address

454 E PRESIDENT AVE
TUPELO MS
38801-5501
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-6470
  • Fax: 662-377-6475
Mailing address:
  • Phone: 662-377-4685
  • Fax: 662-377-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12874
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: