Healthcare Provider Details

I. General information

NPI: 1255420196
Provider Name (Legal Business Name): REB MCMICHAEL M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 HIGHWAY 468 WEST
WHITFIELD MS
39193-0157
US

IV. Provider business mailing address

PO BOX 157A
WHITFIELD MS
39193-0157
US

V. Phone/Fax

Practice location:
  • Phone: 601-351-8000
  • Fax: 601-351-8301
Mailing address:
  • Phone: 601-351-8000
  • Fax: 601-351-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number08383
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: