Provider Demographics
NPI:1558965384
Name:PHYSICIANS SERVICES GROUP OF MISSISSIPPI, P.C.
Entity Type:Organization
Organization Name:PHYSICIANS SERVICES GROUP OF MISSISSIPPI, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN-MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-503-9096
Mailing Address - Street 1:3401 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-5101
Mailing Address - Country:US
Mailing Address - Phone:228-471-3169
Mailing Address - Fax:228-471-3170
Practice Address - Street 1:3401 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-5101
Practice Address - Country:US
Practice Address - Phone:228-471-3169
Practice Address - Fax:228-471-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty