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

Cody Wayne Cissom, DO

Individual provider Internal Medicine Physician · NPI 1104511153

Cody Wayne Cissom, DO is an Internal Medicine Physician in Tupelo, Mississippi. Licensed in Mississippi. Registered with an NPI since 2023.

Licensed in
MS
In the registry since
2023
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

830 S Gloster St
Tupelo, MS 38801-4996
Phone: (662) 377-3000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence PENDING (MS)

Record details

NPI number1104511153
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedApril 6, 2023
Last updated in NPPESApril 6, 2023
Certification dateMarch 26, 2023
Mailing address830 S Gloster St, Tupelo, MS 38801-4996

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