Healthcare Provider Details

I. General information

NPI: 1588845523
Provider Name (Legal Business Name): J RAPHA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CALHOUN AVE
YAZOO CITY MS
39194-2938
US

IV. Provider business mailing address

P. O. BOX 948
YAZOO CITY MS
39194-2938
US

V. Phone/Fax

Practice location:
  • Phone: 662-746-4700
  • Fax: 662-746-0022
Mailing address:
  • Phone: 662-746-4700
  • Fax: 662-746-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC16081
License Number StateMS

VIII. Authorized Official

Name: MRS. ROBBIN ALEXANDER WRIGHT
Title or Position: CERTIFIED PROSTHETIST
Credential: BOCP
Phone: 662-746-4700