Provider Demographics
NPI:1912461328
Name:GRAY, TALMADGE RHODES (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TALMADGE
Middle Name:RHODES
Last Name:GRAY
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:TAL
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:1818 COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305
Mailing Address - Country:US
Mailing Address - Phone:601-581-7600
Mailing Address - Fax:
Practice Address - Street 1:1818 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305
Practice Address - Country:US
Practice Address - Phone:601-581-7600
Practice Address - Fax:601-581-8030
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903075363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health