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General NPI Number Information
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NPI Number | 1447947171
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI MEDICAL GROUP, INC
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 101 WEBSTER CIR STE 300
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City | MADISON
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State | MS
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Zip | 39110-7789
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Country | US
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Telephone | 601-573-2294
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Fax | 601-391-1951
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Provider Business Mailing Address
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Address Line | 101 WEBSTER CIR STE 300
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City | MADISON
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State | MS
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Zip | 39110-7789
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Country | US
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Telephone | 601-348-8988
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Fax | 601-391-1951
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Authorized Official
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Title or Position | PRESIDENT/MANAGER
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Name | MISS TERESA GRAHAM
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Credential |
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Telephone | 601-500-1268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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