Healthcare Provider Details

I. General information

NPI: 1376557462
Provider Name (Legal Business Name): ROBERT B BRITT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 HIGHWAY 51 N
BROOKHAVEN MS
39601-2350
US

IV. Provider business mailing address

427 HIGHWAY 51 N
BROOKHAVEN MS
39601-2350
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-6011
  • Fax: 601-833-5210
Mailing address:
  • Phone: 601-833-6011
  • Fax: 601-833-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMS11701
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: