# DIABETES AND ENDOCRINE CENTER OF MS

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

## Provider details

- **NPI number:** 1568764504
- **Authorized official:** TERRI FEWELL (OFFICE MANAGER)
- **Authorized official phone:** (601) 292-1228

## Contact information

- **Practice address:** 971 LAKELAND DR, SUITE 450, JACKSON, MS 39216-4643
- **Practice address phone:** (601) 948-5158
- **Practice address fax:** (601) 326-4265
- **Mailing address:** 971 LAKELAND DR, SUITE 450, JACKSON, MS 39216-4643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 19640 | MS | — |
| 174400000X | Specialist | 20965 | MS | — |
| 174400000X | Specialist | 21031 | MS | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/24/2010
- **Last updated:** 05/30/2023