Healthcare Provider Details

I. General information

NPI: 1093278582
Provider Name (Legal Business Name): HATTIESBURG MUSCULOSKELETAL MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WINDSTONE
HATTIESBURG MS
39402-1254
US

IV. Provider business mailing address

23 WINDSTONE
HATTIESBURG MS
39402-1254
US

V. Phone/Fax

Practice location:
  • Phone: 601-336-2525
  • Fax:
Mailing address:
  • Phone: 601-520-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WHITNEY DANJACK LYNCH
Title or Position: PHYSICIAN/MEMBER
Credential: DO
Phone: 601-520-7012