Healthcare Provider Details

I. General information

NPI: 1104374750
Provider Name (Legal Business Name): GREGORY A. AUZENNE MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 03/17/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 29TH AVE STE A
MERIDIAN MS
39305-2675
US

IV. Provider business mailing address

P O BOX 649107
DALLAS TX
75264
US

V. Phone/Fax

Practice location:
  • Phone: 601-286-5477
  • Fax: 601-286-5425
Mailing address:
  • Phone: 601-286-5477
  • Fax: 601-286-5825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number20220
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20220
License Number StateMS

VIII. Authorized Official

Name: DR. GREGORY A AUZENNE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 601-286-5477