| Roscoe L. Douglas, Ph.d., P.a. | |
|
1207 White Oak Dr Meridian MS 39305-1902 | |
| (601) 483-8370 | |
| (601) 482-4248 |
| Full Name | Roscoe L. Douglas, Ph.d., P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 1207 White Oak Dr, Meridian, Mississippi |
| Authorized Official Name and Position | Roscoe Lormer Douglas (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 6014838370 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roscoe L. Douglas, Ph.d., P.a. Po Box 3545 Meridian MS 39303-3545 Ph: (601) 483-8370 | Roscoe L. Douglas, Ph.d., P.a. 1207 White Oak Dr Meridian MS 39305-1902 Ph: (601) 483-8370 |
| NPI Number | 1760686299 |
|---|---|
| Provider Enumeration Date | 06/11/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8022191451 |
|---|---|
| Medicare Enrollment ID | O20080208000193 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760686299 | NPI | - | NPPES |
| 00017960 | Medicaid | MS | |
| 1740494434 | Other | MS | NPI INDIV PROV NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 139 (Mississippi) | Primary |
| Provider Name | Roscoe L Douglas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740494434 PECOS PAC ID: 5092898429 Enrollment ID: I20110216000636 |
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