Provider Demographics
NPI:1881702710
Name:BISHOP, ANDREW CHARLES (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHARLES
Last Name:BISHOP
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 1:971 LAKELAND DR STE 654
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4605
Mailing Address - Country:US
Mailing Address - Phone:601-982-1010
Mailing Address - Fax:601-366-0436
Practice Address - Street 1:971 LAKELAND DR STE 654
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4605
Practice Address - Country:US
Practice Address - Phone:601-982-1010
Practice Address - Fax:601-366-0436
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS099402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018147Medicaid
MS260000107Medicare ID - Type Unspecified
B63031Medicare UPIN