Healthcare Provider Details

I. General information

NPI: 1013425503
Provider Name (Legal Business Name): PATHWAY HEALTHCARE- MISSISSIPPI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR
VICKSBURG MS
39180-5187
US

IV. Provider business mailing address

1000 URBAN CENTER DR STE 600
VESTAVIA AL
35242-2584
US

V. Phone/Fax

Practice location:
  • Phone: 601-883-0264
  • Fax: 601-883-0266
Mailing address:
  • Phone: 205-208-9312
  • Fax: 205-848-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW TURNER
Title or Position: PRESIDENT/COO
Credential:
Phone: 205-208-9312