# MISSISSIPPI UROLOGY CLINIC, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mississippi Urology Clinic, PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487432852
- **Authorized official:** DR. HAROLD JASON BLALOCK MD (PRESIDENT)
- **Authorized official phone:** (601) 353-9900

## Contact information

- **Practice address:** 1040 RIVER OAKS DR STE 202, FLOWOOD, MS 39232-9534
- **Practice address phone:** (601) 353-9900
- **Practice address fax:** (601) 414-5381
- **Mailing address:** 501 MARSHALL ST STE 301, JACKSON, MS 39202-1687
- **Mailing address phone:** (601) 353-9900
- **Mailing address fax:** (601) 353-3654

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 09/18/2023
- **Last updated:** 09/18/2023