Healthcare Provider Details

I. General information

NPI: 1679079909
Provider Name (Legal Business Name): COLE LITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 DENNY AVE
PASCAGOULA MS
39581-5301
US

IV. Provider business mailing address

2809 DENNY AVE
PASCAGOULA MS
39581-5301
US

V. Phone/Fax

Practice location:
  • Phone: 228-809-5000
  • Fax:
Mailing address:
  • Phone: 937-208-3356
  • Fax: 937-208-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57.250090
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number33570
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: