Healthcare Provider Details

I. General information

NPI: 1497520217
Provider Name (Legal Business Name): EMONI PATTERSON PCCSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1104B CEDAR ST
WAYNESBORO MS
39367-2417
US

IV. Provider business mailing address

PO BOX 18679
HATTIESBURG MS
39404-8679
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-3350
  • Fax: 601-735-9598
Mailing address:
  • Phone: 601-705-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4031
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: