Healthcare Provider Details

I. General information

NPI: 1720277445
Provider Name (Legal Business Name): GULF COAST PSYCHIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 DELMAS AVE
PASCAGOULA MS
39567-4136
US

IV. Provider business mailing address

421 DELMAS AVE
PASCAGOULA MS
39567-4136
US

V. Phone/Fax

Practice location:
  • Phone: 228-696-9224
  • Fax: 228-696-9228
Mailing address:
  • Phone: 228-696-9224
  • Fax: 228-696-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number19819
License Number StateMS

VIII. Authorized Official

Name: SERA K COX
Title or Position: OWNER
Credential: MD
Phone: 228-696-9224