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General NPI Number Information
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NPI Number | 1932908308
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Entity Type | Organization
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Legal Business Name | MIZE FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 208 HIGHWAY 28
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City | MIZE
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State | MS
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Zip | 39116-5867
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Country | US
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Telephone | 615-524-0284
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Fax |
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Provider Business Mailing Address
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Address Line | 310 VIRGIL ST
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City | TAYLORSVILLE
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State | MS
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Zip | 39168-5658
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Country | US
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Telephone | 615-524-0284
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. LELIA SIMPSON
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Credential | FNP-C
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Telephone | 615-524-0284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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