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General NPI Number Information
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NPI Number | 1073612651
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Entity Type | Organization
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Legal Business Name | NEUROSURGERY OF HATTIESBURG, PA
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5003 HARDY ST STE 401
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City | HATTIESBURG
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State | MS
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Zip | 39402-1319
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Country | US
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Telephone | 601-268-8535
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Fax | 601-268-8541
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Provider Business Mailing Address
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Address Line | 5003 HARDY ST STE 401
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City | HATTIESBURG
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State | MS
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Zip | 39402-1319
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Country | US
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Telephone | 601-268-8535
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Fax | 601-268-8541
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KERRY BERNARDO
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Credential | MD
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Telephone | 601-268-8535
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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 | 13446
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License Number State | MS
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