Healthcare Provider Details

I. General information

NPI: 1114488095
Provider Name (Legal Business Name): CHRISTOPHER RYAN RAWLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WEEMS ST
PURVIS MS
39475-4062
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7283
US

V. Phone/Fax

Practice location:
  • Phone: 601-794-2224
  • Fax: 601-579-5240
Mailing address:
  • Phone: 601-794-2224
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27843
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: