Provider Demographics
NPI:1619154051
Name:MNZAVA, CHRISTY MICHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:MICHELLE
Last Name:MNZAVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CHRISTY
Other - Middle Name:MICHELLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 5166
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5166
Mailing Address - Country:US
Mailing Address - Phone:601-703-1485
Mailing Address - Fax:601-703-1488
Practice Address - Street 1:1500 HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5335
Practice Address - Country:US
Practice Address - Phone:601-483-5353
Practice Address - Fax:601-482-1753
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03603016Medicaid