| Pine Grove Behavioral Health | |
|
300 Fairway Dr Hattiesburg MS 39401-7715 | |
| (601) 329-1321 | |
| Not Available |
| Full Name | Pine Grove Behavioral Health |
|---|---|
| Speciality | Internal Medicine |
| Location | 300 Fairway Dr, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Jacob Parker (REGISTERD NURSE) |
| Authorized Official Contact | 6013291321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Grove Behavioral Health 300 Fairway Dr Hattiesburg MS 39401-7715 Ph: (601) 329-1321 | Pine Grove Behavioral Health 300 Fairway Dr Hattiesburg MS 39401-7715 Ph: (601) 329-1321 |
| NPI Number | 1699366542 |
|---|---|
| Provider Enumeration Date | 02/02/2021 |
| Last Update Date | 05/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699366542 | NPI | - | NPPES |
| MS0800375 | Other | MS | LABORATORY |
| MS0800375 | Other | MS | HEALTHCARE PROVIDER EMPLOYEE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 347C00000X | Private Vehicle | (* (Not Available)) | Secondary |
| 347D00000X | Train | (* (Not Available)) | Secondary |
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