| |
502 Broad St Ste 2, Columbia, MS 39429-3037 | |
(601) 736-8282 | |
(601) 736-8333 |
Full Name | |
---|---|
Type | Facility |
Speciality | Podiatrist |
Location | 502 Broad St Ste 2, Columbia, Mississippi |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1902617632 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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415 S 28th Ave, Hattiesburg, MS 39401-7246 Ph: (601) 264-6000 | 502 Broad St Ste 2, Columbia, MS 39429-3037 Ph: (601) 736-8282 |