Delta State University

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

DELTA STATE UNIVERSITY

Practice address

1003 W Sunflower Rd
Cleveland, MS 38733-0001

Phone

(662) 846-4280

NPI assigned

Jul 26, 2011

Last updated

Oct 4, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Abby Havard, LAT

Title

Assistant Ad/Health & Perfromance

Phone

(662) 846-4280

Specialties & licenses 2

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christian Johnston

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Cleveland, MS
  • NPI 1104429620
  NPD
• Jemecia N. Calvin, MS, LPC, NCC

  • Professional Counselor
  • Cleveland, MS
  • NPI 1013225663
  NPD (past)
• Kristen Bridgewater, ATC

  • Athletic Trainer
  • Bellingham, WA
  • NPI 1700343118
  NPD (past)

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1730467648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 W SUNFLOWER RD",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387330001",
            "telephone_number": "166-284-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 W SUNFLOWER RD",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387330001",
            "telephone_number": "662-846-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-26",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A",
        "authorized_official_last_name": "HAVARD",
        "authorized_official_first_name": "ABBY",
        "authorized_official_title_or_position": "ASSISTANT AD/HEALTH & PERFROMANCE",
        "authorized_official_telephone_number": "662-846-4280",
        "authorized_official_credential": "LAT"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delta Radiology PLLC
• Delta Rehabilitation and Healthcare Center of Cleveland, LLC
• Delta Soul Medical Homecare
• Delta Soul Medical Homecare, LLC
• Delta Soul Medical, LLC
• Delta Vein and Artery Center, P. C.
• Delta Wound Care PLLC
• Delta Wound Care Services Inc.
• Mallory McKnight Dill
• Anna Marie Dobbins, PHARMD

• Internal Medicine Physician in Cleveland, MS
• Providers in Cleveland, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.