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6051 U S Highway 49 Hattiesburg MS 39401-7200 | |
| (601) 288-2474 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 6051 U S Highway 49, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Richard Woodard (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6012882892 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 16389 Hattiesburg MS 39404-6389 Ph: () - | 6051 U S Highway 49 Hattiesburg MS 39401-7200 Ph: (601) 288-2474 |
| NPI Number | 1184030587 |
|---|---|
| Provider Enumeration Date | 07/07/2014 |
| Last Update Date | 07/07/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184030587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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