Provider Demographics
NPI:1447947171
Name:MISSISSIPPI MEDICAL GROUP, INC
Entity type:Organization
Organization Name:MISSISSIPPI MEDICAL GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-500-1268
Mailing Address - Street 1:101 WEBSTER CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7789
Mailing Address - Country:US
Mailing Address - Phone:601-348-8988
Mailing Address - Fax:601-391-1951
Practice Address - Street 1:101 WEBSTER CIR STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7789
Practice Address - Country:US
Practice Address - Phone:601-573-2294
Practice Address - Fax:601-391-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Single Specialty