| Southern Medical Care, Pllc | |
|
6600 U S Highway 98 Suite B Hattiesburg MS 39402-8441 | |
| (601) 261-2727 | |
| (601) 261-9847 |
| Full Name | Southern Medical Care, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 6600 U S Highway 98, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Mechelle Duckworth (CEO) |
| Authorized Official Contact | 6012963150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Medical Care, Pllc 6600 U S Highway 98 Suite B Hattiesburg MS 39402-8441 Ph: (601) 261-2727 | Southern Medical Care, Pllc 6600 U S Highway 98 Suite B Hattiesburg MS 39402-8441 Ph: (601) 261-2727 |
| NPI Number | 1033537469 |
|---|---|
| Provider Enumeration Date | 04/02/2014 |
| Last Update Date | 04/02/2014 |
| Medicare PECOS PAC ID | 2769607514 |
|---|---|
| Medicare Enrollment ID | O20140710001840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033537469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Omolara Y Otaigbe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932164456 PECOS PAC ID: 8224112917 Enrollment ID: I20080219000535 |
| Provider Name | Monica Hinojosa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982044913 PECOS PAC ID: 1355571357 Enrollment ID: I20140312001141 |
| Provider Name | Stephen E Massey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740374255 PECOS PAC ID: 0648580183 Enrollment ID: I20151112001040 |
| Provider Name | Barbarita M Dearman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922457266 PECOS PAC ID: 1355622812 Enrollment ID: I20161222000029 |
| Provider Name | Tatum Mayfield Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124632187 PECOS PAC ID: 5799181806 Enrollment ID: I20210914003116 |
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