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General NPI Number Information
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NPI Number | 1053236885
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Entity Type | Individual
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Provider Name | MR. HASANI K BOLDEN
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Gender | Male
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Dates
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Enumeration Date | 08/11/2026
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 1720B MEDICAL PARK DR
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City | BILOXI
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State | MS
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Zip | 39532-2131
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Country | US
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Telephone | 228-822-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 220 VIRGINIA AVE
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City | PICAYUNE
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State | MS
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Zip | 39466-4658
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Country | US
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Telephone | 601-916-9790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 197906
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License Number State | MS
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