# MADISON REGIONAL PHYSICIANS GROUP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417072620
- **Authorized official:** BRAD SINCLAIR (REGIONAL MANAGER)
- **Authorized official phone:** (601) 936-3113

## Contact information

- **Practice address:** 1421 E PEACE ST, CANTON, MS 39046-4938
- **Practice address phone:** (601) 859-1331
- **Mailing address:** 1421 E PEACE ST, CANTON, MS 39046-4938
- **Mailing address phone:** (601) 859-1331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 03/20/2007
- **Last updated:** 09/11/2025