# DELTA PHYSICIAN PRACTICES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DELTA PHYSICIAN PRACTICES
- **Other names:** Delta Health-Greenville Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1174642144
- **Legal business name:** DELTA PHYSICIAN PRACTICES
- **Authorized official:** MS. IRIS STACKER (CEO)
- **Authorized official phone:** (662) 725-2264

## Contact information

- **Practice address:** 1502 S COLORADO ST, GREENVILLE, MS 38703-7219
- **Practice address phone:** (662) 332-9872
- **Mailing address:** PO BOX 23998, JACKSON, MS 39225-3998
- **Mailing address phone:** (662) 725-2749
- **Mailing address fax:** (662) 725-2741

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/28/2007
- **Last updated:** 11/04/2022