Provider Demographics
NPI:1598438483
Name:MCCOY, FULUMIRANI (NP)
Entity Type:Individual
Prefix:
First Name:FULUMIRANI
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 COUNTY ROAD 194
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:38828-9102
Mailing Address - Country:US
Mailing Address - Phone:662-255-6879
Mailing Address - Fax:
Practice Address - Street 1:571 MITCHELL ST STE C
Practice Address - Street 2:
Practice Address - City:GUNTOWN
Practice Address - State:MS
Practice Address - Zip Code:38849-8500
Practice Address - Country:US
Practice Address - Phone:662-348-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine