MEDICARE: DR. BERTHRONE LACALVIN MOCK-MUHAMMAD MD

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	101YM0800X	Mental Health Counselor
2	2251C2600X	Cardiopulmonary Physical Therapist
3	2251E1300X	Clinical Electrophysiology Physical Therapist
4	225700000X	Massage Therapist
5	207RC0000X	Cardiovascular Disease Physician	20402	MS

General Provider Information

NPI Number	:	1285781153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERTHRONE LACALVIN MOCK-MUHAMMAD MD

Provider Business Mailing Address
First Line	:	406 BRIARWOOD DR STE 401
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-3063
Country	:	US
Telephone Number	:	601-707-7899
Fax Number	:	866-304-0148

Provider Business Practice Location Address
First Line	:	406 BRIARWOOD DR STE 401
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-3063
Country	:	US
Telephone Number	:	601-707-7899
Fax Number	:	866-304-0148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	10/27/2023

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