Healthcare Provider Details

I. General information

NPI: 1285857623
Provider Name (Legal Business Name): SOUTH MISSISSIPPI NEPHROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 VIEUX MARCHE
BILOXI MS
39530
US

IV. Provider business mailing address

4300B W RAILROAD ST
GULFPORT MS
39501-2568
US

V. Phone/Fax

Practice location:
  • Phone: 228-374-7525
  • Fax: 228-864-0546
Mailing address:
  • Phone: 228-863-7393
  • Fax: 228-864-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS C LANIER JR.
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 228-863-7393