Healthcare Provider Details

I. General information

NPI: 1962818146
Provider Name (Legal Business Name): THE NEWBORN ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 MARDY ST. WESLEY MEDICAL CENTER
HATTIESBURG MS
39402
US

IV. Provider business mailing address

PO BOX 24356
JACKSON MS
39225-4356
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-8155
  • Fax:
Mailing address:
  • Phone: 601-957-7345
  • Fax: 769-251-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID F. WENDER
Title or Position: TREASURER
Credential: M.D.
Phone: 601-957-7345