Healthcare Provider Details

I. General information

NPI: 1770756082
Provider Name (Legal Business Name): RENIA R DOTSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 HOSPITAL ST
GREENVILLE MS
38703-3213
US

IV. Provider business mailing address

PO BOX 4499
GREENVILLE MS
38704-4499
US

V. Phone/Fax

Practice location:
  • Phone: 662-335-9283
  • Fax:
Mailing address:
  • Phone: 662-335-9283
  • 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: RENIA R DOTSON
Title or Position: OWNER
Credential: MD
Phone: 662-335-9283