Provider Demographics
NPI:1851681969
Name:ANAZIA, TASHEITHA
Entity Type:Individual
Prefix:
First Name:TASHEITHA
Middle Name:
Last Name:ANAZIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PLANTERS PT
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8544
Mailing Address - Country:US
Mailing Address - Phone:601-597-0281
Mailing Address - Fax:
Practice Address - Street 1:23 PLANTERS PT
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8544
Practice Address - Country:US
Practice Address - Phone:601-597-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-10
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD 386222084P0800X
MS245552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05903032Medicaid