Active NPI
V a South
- Physical Therapist
- Jackson, MS
National Provider Identifier
1821152877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT3192
- Legal business name
- V A SOUTH
- Practice address
- 4304 Highway 80 W Ste a
Jackson, MS 39209-5922 - Phone
- (601) 636-6019
- Fax
- (601) 661-8457
- NPI assigned
- Dec 21, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Marcus T Harris, PT
- Title
- Owner
- Phone
- (601) 927-7671
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT3192 | MS | Primary |
| Occupational Therapist | 225X00000X | OT2019 | MS |
Addresses
Primary practice location
4304 Highway 80 W Ste a
Jackson, MS 39209-5922
Mailing address
PO Box 3183
Ridgeland, MS 39158-3183
Phone (601) 636-6019
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00124552 | Medicaid | MS |
Other names 1
- V A SOUTH
National Provider Directory
National Provider DirectoryLocations
4304 Highway 80 W
#A
Jackson, MS 39209
Phone (601) 983-6063
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1757548800000",
"number": "1821152877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3183",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "391583183",
"telephone_number": "601-636-6019",
"fax_number": "601-661-8457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4304 HIGHWAY 80 W STE A",
"city": "JACKSON",
"state": "MS",
"postal_code": "392095922",
"telephone_number": "601-636-6019",
"fax_number": "601-661-8457"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "V A SOUTH",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-21",
"last_updated": "2025-09-11",
"status": "A",
"authorized_official_last_name": "HARRIS",
"authorized_official_first_name": "MARCUS",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "601-927-7671",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "PT"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "MS",
"license": "PT3192",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "MS",
"license": "OT2019",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00124552",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "V A SOUTH",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.