Provider Demographics
NPI:1609016443
Name:CENTRAL MISSISSIPPI NEUROLOGY GROUP PA
Entity type:Organization
Organization Name:CENTRAL MISSISSIPPI NEUROLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAOHONG
Authorized Official - Middle Name:
Authorized Official - Last Name:SI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-824-4354
Mailing Address - Street 1:348 CROSSGATES BLVD STE 2300
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2634
Mailing Address - Country:US
Mailing Address - Phone:601-824-4354
Mailing Address - Fax:601-824-6042
Practice Address - Street 1:348 CROSSGATES BLVD
Practice Address - Street 2:STE 2300
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2700
Practice Address - Country:US
Practice Address - Phone:601-824-4354
Practice Address - Fax:601-824-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20483174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty