Provider Demographics
NPI:1972080257
Name:RIGHT TRACK MEDICAL GROUP, INC
Entity type:Organization
Organization Name:RIGHT TRACK MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:FOWLKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-801-7508
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1437
Mailing Address - Country:US
Mailing Address - Phone:662-234-7601
Mailing Address - Fax:662-234-8531
Practice Address - Street 1:1203 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5327
Practice Address - Country:US
Practice Address - Phone:662-234-7601
Practice Address - Fax:662-234-8531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2021-03-15
Deactivation Date:2021-02-26
Deactivation Code:
Reactivation Date:2021-03-15
Provider Licenses
StateLicense IDTaxonomies
MS218312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty