Healthcare Provider Details

I. General information

NPI: 1215100599
Provider Name (Legal Business Name): S SONGCHAROEN MD, FACS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR SUITE 315
JACKSON MS
39216-4643
US

IV. Provider business mailing address

971 LAKELAND DR SUITE 654
JACKSON MS
39216-4643
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-2525
  • Fax: 601-981-3152
Mailing address:
  • Phone: 601-981-2525
  • Fax: 601-981-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SONGCHAROEN SONGCHAROEN
Title or Position: OWNER
Credential: MD
Phone: 601-981-2525