Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Physician Practice of Madison, PC

Organization Specialist · NPI 1114476389

Physician Practice of Madison, PC is a Specialist in Vicksburg, Mississippi. Licensed in Mississippi. Registered with an NPI since 2016.

Licensed in
MS
In the registry since
2016
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1111 N Frontage Rd Fl 2
Vicksburg, MS 39180-5102
Phone: (412) 721-2417
Fax: (601) 510-2367
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 21500 (MS)

Record details

NPI number1114476389
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shahjahan Sultan — Ceo · (412) 721-2417
Other names Physician Practice Of Madison, Pc
NPI enumeratedSeptember 28, 2016
Last updated in NPPESSeptember 28, 2016
Mailing address6 Eastbrooke Cir, Madison, MS 39110-6537

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