Organization
MS DEPT OF HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PHILLIPS (THIRD PARTY BILLING)
(601) 576-7566
Entity
Organization
Contact information
Practice address
1633 HOSPITAL ST, GREENVILLE, MS 38703-3222
(662) 332-8177
(662) 378-3783
Mailing address
1633 HOSPITAL ST, GREENVILLE, MS 38703-3222
(662) 332-8177
(662) 378-3783
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
R511587
MS
Other
Enumeration date
02/07/2007
Last updated
08/22/2020
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