Healthcare Provider Details

I. General information

NPI: 1265627467
Provider Name (Legal Business Name): SOUTH PIKE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W MYRTLE ST
MAGNOLIA MS
39652-2717
US

IV. Provider business mailing address

205 W MYRTLE ST
MAGNOLIA MS
39652-2717
US

V. Phone/Fax

Practice location:
  • Phone: 601-783-2312
  • Fax: 601-783-4179
Mailing address:
  • Phone: 601-783-2312
  • Fax: 601-783-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR865890
License Number StateMS

VIII. Authorized Official

Name: DR. BILL GUNNELL
Title or Position: SUPERINTENDENT
Credential:
Phone: 601-783-2312