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General NPI Number Information
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NPI Number | 1346036977
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Entity Type | Organization
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Legal Business Name | MID-SOUTH DIRECT PRIMARY CARE
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 1229 MS-42 SUITE 270
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City | PETAL
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State | MS
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Zip | 39465
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Country | US
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Telephone | 769-223-9503
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Fax | 601-336-4925
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Provider Business Mailing Address
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Address Line | 1229 MS-42 SUITE 270
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City | PETAL
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State | MS
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Zip | 39465
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Country | US
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Telephone | 769-223-9503
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Fax | 601-336-4925
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Authorized Official
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Title or Position | D.O./ADMINISTRATOR
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Name | ASHLEE HENDRY
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Credential | DO
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Telephone | 769-223-9503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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