Organization
DELTA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRIS STACKER (CEO)
(662) 378-3783
Entity
Organization
Contact information
Practice address
1693 FAIRGROUNDS RD, GREENVILLE, MS 38703-7810
(662) 725-2749
(662) 725-2741
Mailing address
PO BOX 1734, GREENVILLE, MS 38702-1734
(662) 725-2749
(662) 725-2741
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
—
208200000X
Plastic Surgery Physician
—
—
2084N0400X
Neurology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015100
—
MS
05
—
156272002
—
AR
Enumeration date
07/15/2006
Last updated
11/14/2022
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