Provider Demographics
NPI:1043433303
Name:GUY T. VISE JR., M.D.
Entity Type:Organization
Organization Name:GUY T. VISE JR., M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:T
Authorized Official - Last Name:VISE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:601-366-5998
Mailing Address - Street 1:890 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4644
Mailing Address - Country:US
Mailing Address - Phone:601-366-5998
Mailing Address - Fax:601-366-4225
Practice Address - Street 1:890 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4644
Practice Address - Country:US
Practice Address - Phone:601-366-5998
Practice Address - Fax:601-366-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06369174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty