Healthcare Provider Details

I. General information

NPI: 1093887945
Provider Name (Legal Business Name): GARY DWAIN CARR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6858 SWINNEA RD BLDG 7
SOUTHAVEN MS
38671-9493
US

IV. Provider business mailing address

201 METHODIST BLVD STE 100
HATTIESBURG MS
39402-1267
US

V. Phone/Fax

Practice location:
  • Phone: 662-510-8400
  • Fax: 662-510-8500
Mailing address:
  • Phone: 601-296-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number10683
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10683
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: