Provider Demographics
NPI:1841222437
Name:DELTA HILLS NEPHROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:DELTA HILLS NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-453-5208
Mailing Address - Street 1:609 TALLAHATCHIE ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2005
Mailing Address - Country:US
Mailing Address - Phone:662-453-5208
Mailing Address - Fax:662-453-4546
Practice Address - Street 1:DELTA HILLS NEPHROLOGY ASSOCIATES
Practice Address - Street 2:609 TALLAHATCHIE STREET
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930
Practice Address - Country:US
Practice Address - Phone:662-453-5208
Practice Address - Fax:662-453-7367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014642Medicaid
MSC02339Medicare PIN