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General NPI Number Information
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NPI Number | 1235258252
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Entity Type | Organization
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Legal Business Name | DELTA PHYSICIAN PRACTICES
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 526 FAIRVIEW AVE
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City | GREENVILLE
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State | MS
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Zip | 38701-5401
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Country | US
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Telephone | 662-332-0501
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Fax | 662-332-0176
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Provider Business Mailing Address
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Address Line | PO BOX 23998
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City | JACKSON
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State | MS
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Zip | 39225-3998
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Country | US
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Telephone | 662-725-2749
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Fax | 662-725-2741
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Authorized Official
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Title or Position | CEO
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Name | IRIS STACKER
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Credential |
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Telephone | 662-378-3783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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