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
344 ARNOLD AVE, GREENVILLE, MS 38701-4711
(662) 332-8131
(662) 334-4478
Mailing address
PO BOX 23998, JACKSON, MS 39225-3998
(662) 725-2749
(662) 725-2741
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
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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