Journeypure Mississippi Medical Group LLC

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

Legal business name

JOURNEYPURE MISSISSIPPI MEDICAL GROUP LLC

Practice address

8829 Centre St
Southaven, MS 38671-2610

Phone

(662) 536-6542

Fax

(662) 314-9689

NPI assigned

Nov 22, 2016

Organization subpart

No

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

Authorized official

Name

Kim Cooper

Title

Human Resources

Phone

(662) 536-6542

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592265600000",
    "number": "1780127845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8829 CENTRE ST STE 200",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712610",
            "telephone_number": "662-536-6542",
            "fax_number": "662-314-9689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8829 CENTRE ST",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712610",
            "telephone_number": "662-536-6542",
            "fax_number": "662-314-9689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOURNEYPURE MISSISSIPPI MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-22",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "HUMAN RESOURCES",
        "authorized_official_telephone_number": "662-536-6542"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Tate Jones, MD
• Sharunda Jones
• Taylor Jones
• Cheryl Jordan, MS CCC-SLP
• Journey to New Beginnings, PLLC
• Journeypure Southaven, LLC
• Journeypure Southaven, LLC
• Kacey S. Joyner, ATC
• John George Kakales, DDS
• Tracy Elizabeth Kammerer

• Addiction (Substance Use Disorder) Psychologist in Southaven, MS
• Providers in Southaven, MS by specialty
• Addiction (Substance Use Disorder) Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.