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General NPI Number Information
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NPI Number | 1558965384
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SERVICES GROUP OF MISSISSIPPI, P.C.
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 3401 MAIN ST STE A
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City | MOSS POINT
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State | MS
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Zip | 39563-5101
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Country | US
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Telephone | 228-471-3169
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Fax | 228-471-3170
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Provider Business Mailing Address
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Address Line | 3401 MAIN ST STE A
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City | MOSS POINT
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State | MS
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Zip | 39563-5101
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Country | US
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Telephone | 228-471-3169
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Fax | 228-471-3170
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAWN-MICHELE BLALOCK
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Credential |
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Telephone | 252-503-9096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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