Organization
DELTA PHYSICIAN PRACTICES
Active
Parent organization
DELTA PHYSICAIN PRACTICES
Other names
Delta Health-Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
DELTA PHYSICAIN PRACTICES
Authorized official
MS. IRIS STACKER (CEO)
(662) 725-2264
Entity
Organization
Contact information
Practice address
300 S WASHINGTON AVE, GREENVILLE, MS 38701-4719
(662) 378-2020
Mailing address
PO BOX 23998, JACKSON, MS 39225-3998
(662) 725-2749
(662) 725-2741
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2084P0800X
Psychiatry Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
—
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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