NPIMap

Organization Active NPI

Pathway Healthcare- Mississippi LLC

  • Addiction Medicine (Family Medicine) Physician
  • Laurel, MS
National Provider Identifier
1013425503
Registry record updated Jun 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
PATHWAY HEALTHCARE- MISSISSIPPI LLC
Practice address
5 Dunnbarr Ste 1
Laurel, MS 39440-1041
Phone
(662) 434-4210
Fax
(205) 848-2227
NPI assigned
Jan 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kristina Moore
Title
Data and Integration
Phone
(205) 208-9312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X Primary

Addresses

Primary practice location

5 Dunnbarr Ste 1
Laurel, MS 39440-1041

Mailing address

48 Medical Park Dr E Ste 453
Birmingham, AL 35235-3472
Phone (205) 208-9312

Other practice location 1

2655 Lakeland Dr
Flowood, MS 39232-9516
Phone (601) 957-7343

Other practice location 2

605 2nd Ave N
Columbus, MS 39701-4513
Phone (662) 434-4210

Other names 1

  • Pathway Healthcare Laurel MS Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180308001891 MS Part B Supplier - Clinic/Group Practice 3779844774 Receives reassigned benefits from 9 practitioners
Practice locations: Columbus, MS; Laurel, MS; Flowood, MS

National Provider Directory

National Provider Directory

Locations

1005 W Market St
Ste 8
Athens, AL 35611
Phone (256) 233-1650

48 Medical Park Dr E
Ste 4530
Birmingham, AL 35235

400 Bexar Ave W
Hamilton, AL 35570
Phone (205) 921-2838

2010 S Point Park Cir
Huntsville, AL 35801

580 Providence Park Dr E
#125A
Mobile, AL 36695

580 Providence Park Dr E
Ste A
Mobile, AL 36695

5 Dunnbarr
Ste 1
Laurel, MS 39440
Phone (601) 426-3421

4000 Pemberton Square Blvd
#1
Vicksburg, MS 39180

1 Medical Plaza Dr
#A
Vicksburg, MS 39180

4000 Pemberton Square Blvd
Vicksburg, MS 39180

37 Sandstone Cir
Ste 110
Jackson, TN 38305
Phone (731) 337-4506

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2142690Pathway Healthcare2655 Lakeland Drive, Flowood, MS 39232Certificate of waiverJan 17, 2028
25D2147380Pathway Healthcare - Mississippi LLC605 2ND Ave N Ste B, Columbus, MS 39701Certificate of waiverJan 4, 2028

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782172800000",
    "number": "1013425503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 MEDICAL PARK DR E STE 453",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352353472",
            "telephone_number": "205-208-9312",
            "fax_number": "205-848-2227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 DUNNBARR STE 1",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394401041",
            "telephone_number": "662-434-4210",
            "fax_number": "205-848-2227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2655 Lakeland Dr",
            "address_purpose": "LOCATION",
            "city": "Flowood",
            "state": "MS",
            "postal_code": "392329516",
            "country_code": "US",
            "telephone_number": "601-957-7343",
            "fax_number": "601-957-7344",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "605 2nd Ave N",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "MS",
            "postal_code": "397014513",
            "country_code": "US",
            "telephone_number": "662-434-4210",
            "fax_number": "662-657-1044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PATHWAY HEALTHCARE- MISSISSIPPI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "DATA AND INTEGRATION",
        "authorized_official_telephone_number": "205-208-9312"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pathway Healthcare Laurel MS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.