Healthcare Provider Details

I. General information

NPI: 1497002810
Provider Name (Legal Business Name): SOUTHERN BONE & JOINT SPECIALISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HOLLY AVE
COLLINS MS
39428-3894
US

IV. Provider business mailing address

3688 VETERANS MEMORIAL DR SUITE 200
HATTIESBURG MS
39401-8246
US

V. Phone/Fax

Practice location:
  • Phone: 601-554-7400
  • Fax: 601-554-7499
Mailing address:
  • Phone: 601-554-7400
  • Fax: 601-554-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID M BURCKEL
Title or Position: CEO
Credential:
Phone: 601-554-7449