Provider Demographics
NPI:1619154051
Name:MNZAVA, CHRISTY MICHELLE (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:MICHELLE
Last Name:MNZAVA
Suffix:
Gender:
Credentials:DO
Other - Prefix:DR
Other - First Name:CHRISTY
Other - Middle Name:MICHELLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2514 67TH AVENUE LOOP STE 106
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-7260
Mailing Address - Country:US
Mailing Address - Phone:601-282-5315
Mailing Address - Fax:601-282-5437
Practice Address - Street 1:2514 67TH AVENUE LOOP STE 106
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-7260
Practice Address - Country:US
Practice Address - Phone:601-282-5315
Practice Address - Fax:601-282-5437
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03603016Medicaid