Healthcare Provider Details

I. General information

NPI: 1457443897
Provider Name (Legal Business Name): WILLIAM KNOX AUSTIN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MARION AVENUE
MCCOMB MS
39648
US

IV. Provider business mailing address

P.O. BOX 666
MCCOMB MS
39649
US

V. Phone/Fax

Practice location:
  • Phone: 601-684-1250
  • Fax: 601-684-0129
Mailing address:
  • Phone: 601-684-1250
  • Fax: 601-684-0129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number05952
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: