Roscoe L. Douglas, PH.D., P.a.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

139 Issued in MS

Legal business name

ROSCOE L. DOUGLAS, PH.D., P.A.

Practice address

1207 White Oak Dr
Meridian, MS 39305-1902

Phone

(601) 483-8370

Fax

(601) 482-4248

NPI assigned

Jun 11, 2007

Organization subpart

No

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

Authorized official

Name

Roscoe Lormer Douglas, PH.D.

Title

Clinical Psychologist

Phone

(601) 483-8370

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760686299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3545",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393033545",
            "telephone_number": "601-483-8370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 WHITE OAK DR",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393051902",
            "telephone_number": "601-483-8370",
            "fax_number": "601-482-4248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSCOE L. DOUGLAS, PH.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "ROSCOE",
        "authorized_official_middle_name": "LORMER",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "601-483-8370",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MS",
            "license": "139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00017960",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIV PROV NUMBER",
            "identifier": "1740494434",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.