Healthcare Provider Details

I. General information

NPI: 1598082802
Provider Name (Legal Business Name): TREE HOUSE MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HIGHWAY 49 STE B
WIGGINS MS
39577-8013
US

IV. Provider business mailing address

2201 HIGHWAY 49 STE B
WIGGINS MS
39577-8013
US

V. Phone/Fax

Practice location:
  • Phone: 601-528-9006
  • Fax: 601-528-9046
Mailing address:
  • Phone: 601-528-9006
  • Fax: 601-528-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18201
License Number StateMS

VIII. Authorized Official

Name: DR. DOUG A MCBRIDE
Title or Position: OWNER
Credential: MD
Phone: 601-528-9006