Provider Demographics
NPI:1629378971
Name:PMT CLINIC
Entity Type:Organization
Organization Name:PMT CLINIC
Other - Org Name:PSYCHIATRIC MEDICINE AND THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:W
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-366-4696
Mailing Address - Street 1:1855 LAKELAND DR
Mailing Address - Street 2:SUITE P101
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4913
Mailing Address - Country:US
Mailing Address - Phone:601-366-4696
Mailing Address - Fax:601-366-6574
Practice Address - Street 1:1855 LAKELAND DR
Practice Address - Street 2:SUITE P101
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4913
Practice Address - Country:US
Practice Address - Phone:601-366-4696
Practice Address - Fax:601-366-6574
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUG BYRD, MD, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15999103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty