Healthcare Provider Details

I. General information

NPI: 1336866615
Provider Name (Legal Business Name): INSPIRED HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 MISSION 66
VICKSBURG MS
39183-2752
US

IV. Provider business mailing address

PO BOX 550
CLINTON MS
39060-0550
US

V. Phone/Fax

Practice location:
  • Phone: 601-876-7003
  • Fax:
Mailing address:
  • Phone: 601-876-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHINITA REED DUDLEY
Title or Position: OWNER
Credential: MD
Phone: 601-213-7681