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General NPI Number Information
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NPI Number | 1144460064
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Entity Type | Organization
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Legal Business Name | GOLDEN TRIANGLE UROLOGY PLLC
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 321 HOSPITAL DR SUITE 1
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City | COLUMBUS
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State | MS
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Zip | 39705-1920
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Country | US
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Telephone | 662-327-2921
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Fax | 662-328-6858
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Provider Business Mailing Address
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Address Line | 321 HOSPITAL DR SUITE 1
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City | COLUMBUS
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State | MS
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Zip | 39705-1920
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Country | US
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Telephone | 662-327-2921
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Fax | 662-328-6858
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KEVIN H BOND
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Credential | M.D.
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Telephone | 662-327-2921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 12474
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License Number State | MS
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