Healthcare Provider Details

I. General information

NPI: 1023276946
Provider Name (Legal Business Name): INLAND FAMILY PRACTICE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 HARDY ST STE 10
HATTIESBURG MS
39402-1614
US

IV. Provider business mailing address

3700 HARDY ST STE 10
HATTIESBURG MS
39402-1614
US

V. Phone/Fax

Practice location:
  • Phone: 601-602-2014
  • Fax: 601-544-7013
Mailing address:
  • Phone: 601-602-2014
  • Fax: 601-544-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19875
License Number StateMS

VIII. Authorized Official

Name: DR. IKECHUKWU HYGINUS OKORIE
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 601-544-7012