Healthcare Provider Details

I. General information

NPI: 1427068659
Provider Name (Legal Business Name): JOSEPH S MOONEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S RAILROAD AVE
BROOKHAVEN MS
39601-3331
US

IV. Provider business mailing address

201 S RAILROAD AVE
BROOKHAVEN MS
39601-3331
US

V. Phone/Fax

Practice location:
  • Phone: 601-835-0077
  • Fax: 601-835-0095
Mailing address:
  • Phone: 601-835-0077
  • Fax: 601-835-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number10309
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: