=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811764475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELTA HILLS NEPHROLOGY CLINICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2023
-----------------------------------------------------
Last Update Date | 12/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 609 TALLAHATCHIE ST
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38930-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-924-5322
-----------------------------------------------------
Fax | 601-510-9110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1261
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39060-1261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-924-5322
-----------------------------------------------------
Fax | 601-510-9110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | LORI WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-924-5322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------