Healthcare Provider Details

I. General information

NPI: 1881351971
Provider Name (Legal Business Name): SHELBY DOLBEAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LACKEY ST
LEAKESVILLE MS
39451-3108
US

IV. Provider business mailing address

PO BOX 18679
HATTIESBURG MS
39404-8679
US

V. Phone/Fax

Practice location:
  • Phone: 601-934-5047
  • Fax: 601-394-6542
Mailing address:
  • Phone: 601-705-1901
  • Fax: 604-705-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM9997
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: