Healthcare Provider Details

I. General information

NPI: 1386389583
Provider Name (Legal Business Name): JOSHUA HUNTER AULTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 MISSION 66
VICKSBURG MS
39183-3137
US

IV. Provider business mailing address

109 MILLSAPS DR
HATTIESBURG MS
39402-1587
US

V. Phone/Fax

Practice location:
  • Phone: 601-638-2081
  • Fax:
Mailing address:
  • Phone: 601-255-0736
  • Fax: 601-255-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number33693
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: