Healthcare Provider Details

I. General information

NPI: 1831021450
Provider Name (Legal Business Name): SOUTHERN SOUND DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MAGNOLIA FARMS DR
LUCEDALE MS
39452-1200
US

IV. Provider business mailing address

120 MAGNOLIA FARMS DR
LUCEDALE MS
39452-1200
US

V. Phone/Fax

Practice location:
  • Phone: 228-761-6734
  • Fax:
Mailing address:
  • Phone: 228-761-6734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEE BUSH
Title or Position: CEO
Credential: BUSH
Phone: 228-761-6734