OrganizationActive
Vicksburg Clinic LLC
NPI 1659307791 · Infectious Disease Physician · Vicksburg, MS
Provider details
- NPI number
- 1659307791
- Entity type
- Organization
- Primary specialty
- Infectious Disease PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Debbie Brewer, Director of Provider Enrollment(877) 892-9813
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
- Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians
- Allergy Physician207KA0200X
Allopathic & Osteopathic Physicians
- Cardiovascular Disease Physician207RC0000X
Allopathic & Osteopathic Physicians
- Pediatrics Physician208000000X
Allopathic & Osteopathic Physicians
- Orthopaedic Surgery Physician207X00000X
Allopathic & Osteopathic Physicians
Practice location
1115 N Frontage Rd
Vicksburg, MS 39180-5102
Phone: (601) 634-8790
Approximate (ZIP-level) locationGet directions
Mailing address
1115 N Frontage Rd
Vicksburg, MS 39180-5102
Registry dates
- Enumerated
- 2006-06-23
- Last updated
- 2008-11-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.