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General NPI Number Information
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NPI Number | 1063513141
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Entity Type | Individual
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Provider Name | CHARLES R BRENT MD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 1212 SOUTH 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39402
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Country | US
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Telephone | 601-475-2430
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 SOUTH 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39402
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Country | US
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Telephone | 601-475-2430
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 9082
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 09082
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License Number State | MS
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