Healthcare Provider Details

I. General information

NPI: 1740711316
Provider Name (Legal Business Name): HANNAH GWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BROAD AVE SUITE 310
GULFPORT MS
39501
US

IV. Provider business mailing address

PO BOX 1810
GULFPORT MS
39502
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-1400
  • Fax: 228-575-1414
Mailing address:
  • Phone: 228-576-1194
  • Fax: 228-575-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number162787
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30022
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: