Facts
- Status
- A
- Credential
- O.D.
- Type
- Individual
- Enumeration date
- 2008-08-18
- Last updated
- 2009-04-14
Specialties
Licenses
- License MS
- 800
Location
- Practice location
- 301 HIGHWAY 51 S, SUITE B
- City
- BROOKHAVEN MS
- Postal code
- 396013247
- Phone
- 601-833-6000
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.