Healthcare Provider Details

I. General information

NPI: 1205935269
Provider Name (Legal Business Name): RENIA R DOTSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 E UNION ST
GREENVILLE MS
38703-3253
US

IV. Provider business mailing address

1636 ANNE STOKES RD
GREENVILLE MS
38701-6907
US

V. Phone/Fax

Practice location:
  • Phone: 662-332-0040
  • Fax: 662-332-5008
Mailing address:
  • Phone: 662-334-9691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number16993
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: