Provider Demographics
NPI:1215048939
Name:ACCENT PLASTIC & RECONSTRUCTIVE SURGERY
Entity type:Organization
Organization Name:ACCENT PLASTIC & RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-6290
Mailing Address - Street 1:607 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6337
Mailing Address - Country:US
Mailing Address - Phone:662-377-6290
Mailing Address - Fax:662-377-2755
Practice Address - Street 1:607 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6337
Practice Address - Country:US
Practice Address - Phone:662-377-6290
Practice Address - Fax:662-377-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112173Medicaid
MS512I240008OtherMEDICARE PTAN
MS512G700031OtherMEDICARE GROUP
MSF62573Medicare UPIN
MS240000097Medicare ID - Type Unspecified