Healthcare Provider Details

I. General information

NPI: 1598879009
Provider Name (Legal Business Name): DIGESTIVE DISEASES CENTER OF HATTIESBURG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TURTLE CREEK DR STE 4
HATTIESBURG MS
39402-1173
US

IV. Provider business mailing address

100 METHODIST HOSPITAL BLVD
HATTIESBURG MS
39402-1295
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-5189
  • Fax: 601-268-5006
Mailing address:
  • Phone: 601-268-5189
  • Fax: 601-268-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN E BUCKLEY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 601-268-5189