Provider Demographics
NPI:1992008429
Name:DELORA A. DENNEY, M.D.
Entity Type:Organization
Organization Name:DELORA A. DENNEY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER, CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELORA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-798-5281
Mailing Address - Street 1:12 MEDICAL PLAZA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-9197
Mailing Address - Country:US
Mailing Address - Phone:601-798-5281
Mailing Address - Fax:601-799-5778
Practice Address - Street 1:12 MEDICAL PLAZA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-9197
Practice Address - Country:US
Practice Address - Phone:601-798-5281
Practice Address - Fax:601-799-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-05
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114295Medicaid
MS00114295Medicaid
MS080001982Medicare PIN