Healthcare Provider Details

I. General information

NPI: 1962144626
Provider Name (Legal Business Name): CARLSON SAMA BABILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date: 03/16/2023
Reactivation Date: 04/20/2023

III. Provider practice location address

215 MARION AVE
MCCOMB MS
39648-2705
US

IV. Provider business mailing address

PO BOX 490
MCCOMB MS
39649-0490
US

V. Phone/Fax

Practice location:
  • Phone: 601-249-5500
  • Fax: 601-249-1714
Mailing address:
  • Phone: 601-250-4366
  • Fax: 601-250-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36860
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: