Healthcare Provider Details

I. General information

NPI: 1124409339
Provider Name (Legal Business Name): CHRISTOPHER SUMRALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HIGHWAY 61 N
VICKSBURG MS
39183-8211
US

IV. Provider business mailing address

135 MARION DR.
CLINTON MS
39056
US

V. Phone/Fax

Practice location:
  • Phone: 601-218-6136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR876323
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: