Healthcare Provider Details

I. General information

NPI: 1255654778
Provider Name (Legal Business Name): DONALD GRANT GUILD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 HOLLAND AVE
PHILADELPHIA MS
39350-9121
US

IV. Provider business mailing address

2124 14TH ST
MERIDIAN MS
39301-4040
US

V. Phone/Fax

Practice location:
  • Phone: 601-656-8545
  • Fax: 601-656-3985
Mailing address:
  • Phone: 601-703-3480
  • Fax: 601-703-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22677
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: