Healthcare Provider Details

I. General information

NPI: 1346266921
Provider Name (Legal Business Name): SOUTH COAST FAMILY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2819 DENNY AVE
PASCAGOULA MS
39581-5301
US

IV. Provider business mailing address

2819 DENNY AVE
PASCAGOULA MS
39581-5301
US

V. Phone/Fax

Practice location:
  • Phone: 228-769-2611
  • Fax: 228-762-1638
Mailing address:
  • Phone: 228-769-2611
  • Fax: 228-762-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: JANE A BYRD
Title or Position: OFFICE MANAGER
Credential:
Phone: 228-769-2611