Healthcare Provider Details

I. General information

NPI: 1174517007
Provider Name (Legal Business Name): MELISSA B ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 10/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2899 WEST 4TH STREET
HATTIESBURG MS
39406
US

IV. Provider business mailing address

118 COLLEGE DRIVE BOX 5066
HATTIESBURG MS
39406
US

V. Phone/Fax

Practice location:
  • Phone: 601-266-5370
  • Fax: 601-266-4205
Mailing address:
  • Phone: 601-266-5390
  • Fax: 601-266-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number15983
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: