Healthcare Provider Details

I. General information

NPI: 1588619621
Provider Name (Legal Business Name): DWALIA SHERREE SOUTH-BITTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 COUNTY ROAD 815
RIPLEY MS
38663-8201
US

IV. Provider business mailing address

1721 HIGHWAY 4 W
RIPLEY MS
38663-9678
US

V. Phone/Fax

Practice location:
  • Phone: 662-837-7523
  • Fax: 662-837-7003
Mailing address:
  • Phone: 662-837-0000
  • Fax: 662-837-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number09188
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: