Healthcare Provider Details

I. General information

NPI: 1598675472
Provider Name (Legal Business Name): ETERNA PRIMARY CARE OF MISSISSIPPI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S THOMAS ST STE 204
TUPELO MS
38801-5337
US

IV. Provider business mailing address

730 COOL SPRINGS BLVD STE 200
FRANKLIN TN
37067-7290
US

V. Phone/Fax

Practice location:
  • Phone: 606-306-7706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: PENNY LOGAN
Title or Position: CHIEF OPERATING OFFICER
Credential: MSN, MBA, APRN
Phone: 606-306-7706