# DELTA STATE UNIVERSITY

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

## Provider details

- **NPI number:** 1730467648
- **Authorized official:** ABBY HAVARD LAT (ASSISTANT AD/HEALTH & PERFROMANCE)
- **Authorized official phone:** (662) 846-4280

## Contact information

- **Practice address:** 1003 W SUNFLOWER RD, CLEVELAND, MS 38733-0001
- **Practice address phone:** (662) 846-4280
- **Mailing address:** 1003 W SUNFLOWER RD, CLEVELAND, MS 38733-0001
- **Mailing address phone:** (166) 284-6428

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 2255A2300X | Athletic Trainer | — | NULL | — |
| 2255A2300X | Athletic Trainer | — | — | — |

## Other

- **Enumeration date:** 07/26/2011
- **Last updated:** 10/04/2021