Provider Demographics
NPI:1992024459
Name:BERRY, DAVID MCINNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MCINNIS
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 LAKELAND BLVD
Mailing Address - Street 2:B 12
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8912
Mailing Address - Country:US
Mailing Address - Phone:601-853-2626
Mailing Address - Fax:
Practice Address - Street 1:270 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MS
Practice Address - Zip Code:39631-0639
Practice Address - Country:US
Practice Address - Phone:601-645-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21038207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06439090Medicaid
MS06439090Medicaid