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General NPI Number Information
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NPI Number | 1235329020
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Entity Type | Organization
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Legal Business Name | CENTER OF INFECTIOUS DISEASE EXCELLENCE
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 1040 RIVER OAKS DR SUITE 303
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City | JACKSON
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State | MS
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Zip | 39232-9530
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Country | US
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Telephone | 601-936-0706
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Fax | 601-936-6150
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Provider Business Mailing Address
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Address Line | 1040 RIVER OAKS DR SUITE 303
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City | JACKSON
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State | MS
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Zip | 39232-9530
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Country | US
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Telephone | 601-936-0706
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Fax | 601-936-6150
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | BRAD SINCLAIR
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Credential |
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Telephone | 601-936-3102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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