Healthcare Provider Details

I. General information

NPI: 1144460064
Provider Name (Legal Business Name): GOLDEN TRIANGLE UROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 HOSPITAL DR SUITE 1
COLUMBUS MS
39705-1920
US

IV. Provider business mailing address

321 HOSPITAL DR SUITE 1
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 H BOND
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 662-327-2921