Healthcare Provider Details

I. General information

NPI: 1164483814
Provider Name (Legal Business Name): CATHERINE CHAREL HULSEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE HULSEY GRAVERSEN MD

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

IV. Provider business mailing address

106 GREENWOOD PL
HATTIESBURG MS
39402-2313
US

V. Phone/Fax

Practice location:
  • Phone: 601-288-4329
  • Fax:
Mailing address:
  • Phone: 985-237-0287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number17541
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.200573
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: