Healthcare Provider Details

I. General information

NPI: 1497768675
Provider Name (Legal Business Name): CHRISTOPHER K. MCCARLEY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST NMMC EAST TOWER, 3RD FLOOR
TUPELO MS
38801-4934
US

IV. Provider business mailing address

PO BOX 7062
TUPELO MS
38802-7062
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-7170
  • Fax: 662-377-2423
Mailing address:
  • Phone: 662-377-7170
  • Fax: 662-377-2423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA020
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: