Healthcare Provider Details

I. General information

NPI: 1780930677
Provider Name (Legal Business Name): DAVID MALLORY PLAIR NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2012
Last Update Date: 07/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 HARDY ST STE 10
HATTIESBURG MS
39402-1553
US

IV. Provider business mailing address

510 N 38TH AVE APT 5
HATTIESBURG MS
39401-5719
US

V. Phone/Fax

Practice location:
  • Phone: 601-602-2014
  • Fax:
Mailing address:
  • Phone: 601-606-6869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR887697
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR887697
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: