MEDICARE: MISSISSIPPI STATE DEPARTMENT OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1023428620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI STATE DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	570 E WOODROW WILSON AVE
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4538
Country	:	US
Telephone Number	:	601-576-7635
Fax Number	:

Provider Business Practice Location Address
First Line	:	3706 JO ANN DRIVE
Second Line	:
City	:	CORINTH
State	:	MS
Zip	:	38834-9062
Country	:	US
Telephone Number	:	662-287-6121
Fax Number	:	662-287-6922

Authorized Official
Title or Position	:	STATE HEALTH OFFICER
Name	:	DR. DANIEL P EDNEY
Credential	:	MD, FACP
Telephone Number	:	601-576-7634

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	06/30/2022

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Directions to “MISSISSIPPI STATE DEPARTMENT OF HEALTH ” Practice Location

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