Healthcare Provider Details

I. General information

NPI: 1841416070
Provider Name (Legal Business Name): HEAD & NECK SURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 RIVER OAKS DRIVE
FLOWOOD MS
39232
US

IV. Provider business mailing address

PO BOX 5345
JACKSON MS
39296-5345
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-5244
  • Fax: 601-939-0545
Mailing address:
  • Phone: 601-932-5244
  • Fax: 601-939-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. PHRONIA CORING
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-932-5244