DOUG FITZGERALD
NPI 1417130600
Counselor - Mental Health in Vicksburg, MS

Q: What is Doug Fitzgerald's NPI number?

The NPI number for Doug Fitzgerald is 1417130600. It was assigned to this individual provider in the NPPES registry on December 11, 2007.

Q: What is Doug Fitzgerald's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Doug Fitzgerald was last updated on December 11, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since December 11, 2007PECOS EnrolledAccepts Medicare Assignment

3444 WISCONSIN AVE, VICKSBURG, MS 39180(601) 638-0031(601) 638-4950 Get Directions Write a Review

NPPES record last updated: December 11, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Doug Fitzgerald NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DOUG FITZGERALD (NPI 1417130600) is an individual mental health provider in Vicksburg, Mississippi and active in the NPI registry since December 2007. He is enrolled in Medicare PECOS and is a graduate of Other (1995).

NPPES Registry Identity

NPI1417130600

Entity TypeIndividualMale

Primary Taxonomy101YM0800X

Provider Legal NameDOUG FITZGERALD

Location Address3444 WISCONSIN AVEVicksburg, MS 39180-5331

Mailing Address3444 Wisconsin AveVicksburg, MS 39180-5331 · (601) 638-0031 · Fax (601) 638-4950

Phone(601) 638-0031

Fax(601) 638-4950

Sole ProprietorNo

Medical School CMSOtherGraduated 1995

Enumeration DateDecember 11, 2007

✔ NPI 1417130600 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

3444 WISCONSIN AVE, Vicksburg, MS 39180

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Doug Fitzgerald is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8527591817

PECOS Enrollment IDI20241024003158

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. ALISHA CREEL LPC

Counselor (Mental Health)