Organization
DELTA PHYSICIAN PRACTICES
Active
Parent organization
DELTA PHYSICIAN PRACTICES
Other names
Delta Health-Greenville Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
DELTA PHYSICIAN PRACTICES
Authorized official
MS. IRIS STACKER (CEO)
(662) 725-2264
Entity
Organization
Contact information
Practice address
1502 S COLORADO ST, GREENVILLE, MS 38703-7219
(662) 332-9872
Mailing address
PO BOX 23998, JACKSON, MS 39225-3998
(662) 725-2749
(662) 725-2741
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015100
—
MS
05
—
156272002
—
AR
Enumeration date
03/28/2007
Last updated
11/04/2022
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