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General NPI Number Information
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NPI Number | 1174677033
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Entity Type | Organization
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Legal Business Name | JOEL B. BURWELL D.O. P.A.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9344 THREE RIVERS RD
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City | GULFPORT
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State | MS
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Zip | 39503-4268
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Country | US
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Telephone | 228-574-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 9344 THREE RIVERS RD
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City | GULFPORT
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State | MS
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Zip | 39503-4268
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Country | US
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Telephone | 228-574-2004
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Fax |
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | GINNY BRYANT
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Credential |
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Telephone | 228-574-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12692
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License Number State | MS
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