Provider Demographics
NPI:1881696862
Name:DENNEY, DELORA A (MD)
Entity type:Individual
Prefix:
First Name:DELORA
Middle Name:A
Last Name:DENNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MEDICAL PLAZA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-9197
Mailing Address - Country:US
Mailing Address - Phone:601-798-5281
Mailing Address - Fax:601-799-5778
Practice Address - Street 1:12 MEDICAL PLAZA BLVD STE B
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-9197
Practice Address - Country:US
Practice Address - Phone:601-798-5281
Practice Address - Fax:601-799-5778
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114295Medicaid
MS00114295Medicaid
080001982Medicare PIN