Healthcare Provider Details

I. General information

NPI: 1063844595
Provider Name (Legal Business Name): ANDREW C JEFFREYS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S MAIN ST
WATER VALLEY MS
38965-2946
US

IV. Provider business mailing address

50 S MAIN ST
WATER VALLEY MS
38965-2946
US

V. Phone/Fax

Practice location:
  • Phone: 662-473-4777
  • Fax: 662-473-2233
Mailing address:
  • Phone: 662-473-4777
  • Fax: 662-473-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5283
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: