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General NPI Number Information
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NPI Number | 1497268312
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Entity Type | Organization
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Legal Business Name | HIGHLAND EMERGENCY PHYSICIANS, PA
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 130 HIGHLAND PKWY
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City | PICAYUNE
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State | MS
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Zip | 39466-5574
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Country | US
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Telephone | 601-358-9590
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Fax | 601-358-9594
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Provider Business Mailing Address
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Address Line | PO BOX 3488 DEPT # 05-143
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City | TUPELO
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State | MS
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Zip | 38803-3488
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Country | US
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Telephone | 601-288-2010
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN CLAYTON NELSON
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Credential | MD
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Telephone | 601-288-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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