Provider Demographics
NPI:1518980887
Name:MESSINA, JOSEPH S JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:MESSINA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SUNSET DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901
Mailing Address - Country:US
Mailing Address - Phone:662-226-1646
Mailing Address - Fax:662-227-1599
Practice Address - Street 1:1300 SUNSET DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901
Practice Address - Country:US
Practice Address - Phone:662-226-1646
Practice Address - Fax:662-226-1646
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS10305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00014661Medicaid
MS333910YWZ1Medicare PIN
MS00014661Medicaid
D00997Medicare UPIN