Healthcare Provider Details

I. General information

NPI: 1225083942
Provider Name (Legal Business Name): ROBERT HOUSTON HARDIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W JACKSON ST
RIDGELAND MS
39157-2401
US

IV. Provider business mailing address

2210 HERITAGE HILL DR
JACKSON MS
39211-5821
US

V. Phone/Fax

Practice location:
  • Phone: 601-499-2873
  • Fax: 601-355-7170
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberEMC0006070
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number18490
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: