MEDICARE: SOUND MIND PSYCHIATRY PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1174157689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUND MIND PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	218B S DENTON RD
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-2810
Country	:	US
Telephone Number	:	662-598-8141
Fax Number	:	662-200-5868

Provider Business Practice Location Address
First Line	:	218B S DENTON RD
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-2810
Country	:	US
Telephone Number	:	662-598-8141
Fax Number	:	662-200-5868

Authorized Official
Title or Position	:	OWNER
Name	:	COLBY PONDER
Credential	:	NP
Telephone Number	:	662-305-5998

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	09/11/2024

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