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General NPI Number Information
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NPI Number | 1992008429
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Entity Type | Organization
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Legal Business Name | DELORA A. DENNEY, M.D.
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Dates
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Enumeration Date | 12/05/2010
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 12 MEDICAL PLAZA BLVD SUITE B
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City | PICAYUNE
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State | MS
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Zip | 39466-9197
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Country | US
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Telephone | 601-798-5281
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Fax | 601-799-5778
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Provider Business Mailing Address
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Address Line | 12 MEDICAL PLAZA BLVD SUITE B
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City | PICAYUNE
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State | MS
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Zip | 39466-9197
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Country | US
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Telephone | 601-798-5281
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Fax | 601-799-5778
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Authorized Official
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Title or Position | PARTNER, CO-OWNER
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Name | DR. DELORA ANN DENNEY
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Credential | MD
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Telephone | 601-798-5281
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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 | 13824
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License Number State | MS
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