Healthcare Provider Details

I. General information

NPI: 1437253515
Provider Name (Legal Business Name): JOHN THOMAS PESSONEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 OLD MOBILE HIGHWAY SUITE 1
PASCAGOULA MS
39581
US

IV. Provider business mailing address

5912 OLD MOBILE HWY SUITE 1
PASCAGOULA MS
39581-4520
US

V. Phone/Fax

Practice location:
  • Phone: 228-471-1000
  • Fax: 228-471-1039
Mailing address:
  • Phone: 228-471-1000
  • Fax: 228-471-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2003000629
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number20863
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: