Provider Demographics
NPI:1447798293
Name:PETERKIN AND ASSOCIATES OF MISSISSIPPI INC
Entity Type:Organization
Organization Name:PETERKIN AND ASSOCIATES OF MISSISSIPPI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:910-759-9472
Mailing Address - Street 1:5155 GALAXIE DRIVE, SUITE F
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206
Mailing Address - Country:US
Mailing Address - Phone:601-398-3455
Mailing Address - Fax:769-251-5715
Practice Address - Street 1:5155 GALAXIE DRIVE, SUITE F
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206
Practice Address - Country:US
Practice Address - Phone:601-398-3455
Practice Address - Fax:769-251-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health