Healthcare Provider Details

I. General information

NPI: 1407943442
Provider Name (Legal Business Name): LEE ANTHONY CARNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 N 15TH AVE
LAUREL MS
39440-2656
US

IV. Provider business mailing address

P.O. BOX 6525
LAUREL MS
39441
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-5421
  • Fax: 601-426-3690
Mailing address:
  • Phone: 601-649-5421
  • Fax: 601-426-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20672
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: