Healthcare Provider Details

I. General information

NPI: 1700966090
Provider Name (Legal Business Name): GREGORY WALKER PIPPIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GREG PIPPIN M.D.

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MARION AVE
MCCOMB MS
39648-2709
US

IV. Provider business mailing address

405 MARION AVE
MCCOMB MS
39648-2709
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 Number33163
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number14971R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number33163
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: