Delta Medical Group
Legal Business Name
Delta Medical Group
NPI Number
1790701134
NPI Type
Organization
Enumeration Date
07/15/2006
Specialties
(Taxonomies)Name
Code
207Q00000X
207RI0200X
207T00000X
207UN0901X
207V00000X
207X00000X
208000000X
208200000X
207RR0500X
Primary Taxonomy
No
No
No
No
No
No
No
No
No
Contact
Information
Purpose
Mailing
Location
Address
PO BOX 1734
1693 FAIRGROUNDS RD
City
Greenville
Greenville
State
MS
MS
Postal Code
38702-1734
38703-7810
Country
US
US
Telephone Number
(662) 725-2749
(662) 725-2749
Authorized Official
Name
Iris Stacker
Title or Position
CEO
Telephone Number
(662) 378-3783
Identifiers
Identifier
156272002
09015100
Identifier State
AR
MS
Identifier Issuer
Unknown
Unknown
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 11/14/2022