Healthcare Provider Details

I. General information

NPI: 1093213951
Provider Name (Legal Business Name): GT UROLOGY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 HOSPITAL DR
COLUMBUS MS
39705-1920
US

IV. Provider business mailing address

321 HOSPITAL DR
COLUMBUS MS
39705-1920
US

V. Phone/Fax

Practice location:
  • Phone: 662-327-2921
  • Fax: 662-328-6858
Mailing address:
  • Phone: 662-327-2921
  • Fax: 662-328-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number12474
License Number StateMS

VIII. Authorized Official

Name: DR. KEVIN BOND
Title or Position: OWNER
Credential: MD
Phone: 662-327-2921