Healthcare Provider Details

I. General information

NPI: 1881491850
Provider Name (Legal Business Name): WAVERLY DANIELLE MCSWAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6098 US 98 HWY E SUITE 60
HATTIESBURG MS
39402
US

IV. Provider business mailing address

75 CROSS CREEK PKWY APT 1104
HATTIESBURG MS
39402-4441
US

V. Phone/Fax

Practice location:
  • Phone: 601-588-5882
  • Fax:
Mailing address:
  • Phone: 601-307-3952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberTA-2981
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: