Organization
DELTA PHYSICIAN PRACTICES
Active
Parent organization
DELTA PHYSICIAN PRACTICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
DELTA PHYSICIAN PRACTICES
Authorized official
IRIS STACKER (CEO)
(662) 378-3783
Entity
Organization
Contact information
Practice address
1202 HOSPITAL ST, GREENVILLE, MS 38703-3213
(662) 335-6703
(662) 335-6705
Mailing address
PO BOX 23998, JACKSON, MS 39225-3998
(662) 725-2749
(662) 725-2741
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015100
—
MS
05
—
156272002
—
AR
Enumeration date
03/28/2007
Last updated
11/14/2022
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