Healthcare Provider Details

I. General information

NPI: 1831199108
Provider Name (Legal Business Name): STUART SAMSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DUNNBARR SUITE 1
LAUREL MS
39440-1041
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-426-9614
  • Fax: 601-399-1592
Mailing address:
  • Phone: 601-426-9614
  • Fax: 601-399-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20992
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: