Healthcare Provider Details

I. General information

NPI: 1952589095
Provider Name (Legal Business Name): MSH PSYCHIATRIC PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 HIGHWAY 468 W
WHITFIELD MS
39193-5529
US

IV. Provider business mailing address

3550 HIGHWAY 468 W P O BOX 157-A
WHITFIELD MS
39193-5529
US

V. Phone/Fax

Practice location:
  • Phone: 601-351-8000
  • Fax: 601-351-8586
Mailing address:
  • Phone: 601-351-8000
  • Fax: 601-351-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31-139
License Number StateMS

VIII. Authorized Official

Name: MS. JACQUELINE KING
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 601-351-8000