Healthcare Provider Details

I. General information

NPI: 1306891205
Provider Name (Legal Business Name): OTOLARYNGOLOGY ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 5TH ST N
COLUMBUS MS
39705-2000
US

IV. Provider business mailing address

2430 5TH ST N
COLUMBUS MS
39705-2000
US

V. Phone/Fax

Practice location:
  • Phone: 662-327-4432
  • Fax: 662-327-9256
Mailing address:
  • Phone: 662-327-4432
  • Fax: 662-327-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN M. GARNER
Title or Position: DIRECTOR
Credential: MD
Phone: 662-327-4432