Healthcare Provider Details

I. General information

NPI: 1235706961
Provider Name (Legal Business Name): FRANKLIN DAVID SOUTHERN-BRUNO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W ERLANGER ST
POPLARVILLE MS
39470-3009
US

IV. Provider business mailing address

110 W ERLANGER ST
POPLARVILLE MS
39470-3009
US

V. Phone/Fax

Practice location:
  • Phone: 601-746-5145
  • Fax: 844-348-9002
Mailing address:
  • Phone: 601-746-5145
  • Fax: 844-348-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC11835
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: