Organization
SPECIALTY ORTHOPEDIC GROUP OF MISSISSIPPI PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNY MILLS (CREDENTIALING/PROVIDER ENROLLMENT)
(662) 767-4200
Entity
Organization
Contact information
Practice address
1211 S GLOSTER ST STE A, TUPELO, MS 38801-6535
(662) 767-4200
Mailing address
1211 S GLOSTER ST STE A, TUPELO, MS 38801-6535
(662) 767-4200
(662) 767-4204
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04722052
—
MS
05
—
07200815
—
MS
Enumeration date
07/10/2015
Last updated
01/31/2020
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