| Southern Neuroscience Center, Pa | |
|
105 Asbury Cir Suite A Hattiesburg MS 39402-1397 | |
| (601) 268-5222 | |
| (601) 296-3508 |
| Full Name | Southern Neuroscience Center, Pa |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 105 Asbury Cir, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Danny M. Sanford (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 6012685222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Neuroscience Center, Pa 105 Asbury Cir Suite A Hattiesburg MS 39402-1397 Ph: (601) 268-5222 | Southern Neuroscience Center, Pa 105 Asbury Cir Suite A Hattiesburg MS 39402-1397 Ph: (601) 268-5222 |
| NPI Number | 1346267325 |
|---|---|
| Provider Enumeration Date | 07/16/2006 |
| Last Update Date | 05/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346267325 | NPI | - | NPPES |
| 09016160 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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