ADDICTION CAMPUSES PROFESSIONAL SERVICES OF MISSISSIPPI, LLC (NPI# 1659990075) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1659990075 |
Entity Type | Organization |
Organization Name | ADDICTION CAMPUSES PROFESSIONAL SERVICES OF MISSISSIPPI, LLC |
Practice Address |
340 Stateline Rd W Southaven MS 38671-1610 |
Mailing Address |
205 Reidhurst Ave Nashville TN 37203-1618 |
Practice Telephone | 6625105387 |
Practice Fax Number | 6623420782 |
Enumeration Date | 2020-04-15 |
Last Update Date | 2020-08-17 |
Authorized Official Name | LEIGH ANN THOMPSON (SENIOR DIRECTOR) |
Authorized Official Telephone | 6159214447 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
Street Address |
340 STATELINE RD W |
City | SOUTHAVEN |
State | MS |
Zip Code | 38671-1610 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1700088085 | Kallol Kumar Saha | Family Medicine | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2007-05-31 |
1851916837 | Amanda Folsom | Nurse Practitioner | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2020-06-15 |
1831728583 | Treneise Hunt-smith | Nurse Practitioner | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2020-04-05 |
1164083747 | Jennifer Gail Ross | Nurse Practitioner | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2019-06-25 |
1073035168 | Jerry D Williams II | Nurse Practitioner | 340 Stateline Rd W, Southaven, MS 38671 | 2017-07-11 |
1356703524 | Addiction Campuses of Mississippi, LLC | Substance Abuse Rehabilitation Facility | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2016-03-25 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285196196 | Emma Tinsley-bowles Long | Social Worker | 8786 Northcreek Blvd, Bldg 8 Apt 3, Southaven, MS 38671 | 2019-04-01 |
1851847586 | Tiffany Lashea Jones | Adult Companion | 8755 Millbranch Road, Southaven, MS 38671 | 2016-09-01 |
1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
1073983052 | Tara Burt | Physical Therapist | 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 | 2015-10-02 |
1295160463 | Ideal Community Care,llc | In Home Supportive Care | 8869 Centre Str #3, Southaven, MS 38671 | 2013-09-06 |
1578995692 | Gregory Charles Eakins Jr. | Optometrist | 338 Goodman Rd West, Southaven, MS 38671 | 2013-07-31 |
1295173169 | Erica R. Martin | Social Worker | 975 Swinnea Rdg Ste 3, Southaven, MS 38671 | 2013-06-12 |
1386918431 | Freds Stores of Tennessee Inc | Pharmacy | 710 Church Road, Southaven, MS 38671 | 2012-03-06 |
1740565613 | Mary Jeanette Scruggs | Pharmacist | 1011 Goodman Rd, Southaven, MS 38671 | 2011-10-11 |
1184919268 | First Pharmacy Services 5 | Pharmacy | 5185a Getwell Rd, Southaven, MS 38671 | 2011-06-16 |
Find all providers in zip 38671 |
Taxonomy Code | 2084A0401X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Addiction Medicine |
A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578709713 | Holloway Psychiatric Services, Inc. | Psychiatry & Neurology | 742d Magnolia St, Madison, MS 39110-8903 | 2008-12-17 |
1003955626 | Scott L. Hambleton | Psychiatry & Neurology | 7048 Old Canton Road, Suite 2001, Ridgeland, MS 39157 | 2007-02-06 |
1558379263 | Kevin Mark Passer | Psychiatry & Neurology | 5317-4 Old Highway 11, Hattiesburg, MS 39402 | 2006-08-04 |
1023034758 | Elizabeth Connell Henderson | Psychiatry & Neurology | 3848 County Road 24, Hickory, MS 39332-2630 | 2006-07-14 |
1477180958 | Wright and Associates Medical Logistics LLC | Psychiatry & Neurology | 1403 43rd Ave, Gulfport, MS 39501-2545 | 2020-03-25 |
1952940454 | Magnolia Counseling Clinic | Psychiatry & Neurology | 590 Highway 6 E, Batesville, MS 38606-3002 | 2019-12-31 |
1497103469 | Sharmayn Sayers-erfourth | Psychiatry & Neurology | 129 E Starling St Ste A, Greenville, MS 38701-4725 | 2016-05-31 |
1437327830 | River Oaks Management Company, LLC | Psychiatry & Neurology | 207 W Jackson St, Suite 1, Ridgeland, MS 39157-2311 | 2008-02-19 |
1972642585 | Randall L Sherman | Psychiatry & Neurology | 1 Lincoln Pkwy Ste 202, Hattiesburg, MS 39402-3261 | 2007-02-06 |
1922101328 | Sreedhar Rao Rayudu | Psychiatry & Neurology | 590 Hwy 6 East, Batesville, MS 38606 | 2006-09-07 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.