Healthcare Provider Details

I. General information

NPI: 1962250597
Provider Name (Legal Business Name): QUINETTE S NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 MAIN ST
COLUMBUS MS
39701-4548
US

IV. Provider business mailing address

23 CHAPMAN CV
COLUMBUS MS
39705-1602
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-8002
  • Fax:
Mailing address:
  • Phone: 662-630-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA-725
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: