Healthcare Provider Details

I. General information

NPI: 1538521901
Provider Name (Legal Business Name): CONSTANCE PHYLEA BARNES-WOODS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HIGHWAY 61 N
VICKSBURG MS
39183-8211
US

IV. Provider business mailing address

2100 HIGHWAY 61 N
VICKSBURG MS
39183-8211
US

V. Phone/Fax

Practice location:
  • Phone: 601-883-3391
  • Fax: 601-883-3318
Mailing address:
  • Phone: 601-883-5000
  • Fax: 601-883-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26688
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: