Provider Demographics
NPI:1275737959
Name:HERZOG & HERZOG, P.A.
Entity Type:Organization
Organization Name:HERZOG & HERZOG, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-981-5757
Mailing Address - Street 1:FORTY-FIVE HUNDRED INTERSATE FIFTY FIVE NORTH
Mailing Address - Street 2:208 HIGHLAND VILLAGE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211
Mailing Address - Country:US
Mailing Address - Phone:601-981-5757
Mailing Address - Fax:601-981-5494
Practice Address - Street 1:FORTY FIVE HUNDRED INTERSTATE FIFTY FIVE NORTH
Practice Address - Street 2:208 HIGHLAND VILLAGE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-981-5757
Practice Address - Fax:601-981-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26348103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS687OtherORGANIZATION ID NUMBER