# PANOLA PHYSICIAN GROUP, LLC

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

## Provider details

- **NPI number:** 1528528874
- **Authorized official:** ASHLEY SMITH (ASSOCIATE CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (817) 253-7630

## Contact information

- **Practice address:** 255 MEDICAL CENTER DRIVE, BATESVILLE, MS 38606
- **Practice address phone:** (662) 563-5611
- **Mailing address:** 303 MEDICAL CENTER DR, BATESVILLE, MS 38606-8608
- **Mailing address phone:** (662) 563-5611
- **Mailing address fax:** (662) 563-0155

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2019
- **Last updated:** 07/07/2026