| |
206 Bay Ave Ste A, Richton, MS 39476-2941 | |
(601) 268-0400 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Podiatrist |
Location | 206 Bay Ave Ste A, Richton, Mississippi |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
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1760905145 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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213E00000X | Podiatrist | 80131 (Mississippi) | Primary |
Mailing Address | Practice Location Address |
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Po Box 16235, Hattiesburg, MS 39404-6235 Ph: (601) 268-0400 | 206 Bay Ave Ste A, Richton, MS 39476-2941 Ph: (601) 268-0400 |