Healthcare Provider Details

I. General information

NPI: 1790760692
Provider Name (Legal Business Name): SURGERY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 PEGRAM DR
TUPELO MS
38801-6319
US

IV. Provider business mailing address

440 PEGRAM DR
TUPELO MS
38801-6319
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-5344
  • Fax: 662-844-5363
Mailing address:
  • Phone: 662-844-5344
  • Fax: 662-844-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA LAWMAN
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 662-844-5344