Healthcare Provider Details

I. General information

NPI: 1740374560
Provider Name (Legal Business Name): SOUTHERN MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 US HWY 98 SUITE B
HATTIESBURG MS
39402
US

IV. Provider business mailing address

6600 US HWY 98 SUITE B
HATTIESBURG MS
39402
US

V. Phone/Fax

Practice location:
  • Phone: 601-261-2727
  • Fax: 601-261-9847
Mailing address:
  • Phone: 601-261-2727
  • Fax: 601-261-9847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

Name: DR. STEPHEN MASSEY
Title or Position: OWNER
Credential: M.D.
Phone: 601-261-2727