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General NPI Number Information
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NPI Number | 1184702532
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Entity Type | Organization
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Legal Business Name | ASTHMA & ALLERGY CLINIC OF HATTIESBURG, PLLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 109 MILLSAPS DR STE C
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City | HATTIESBURG
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State | MS
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Zip | 39402-1587
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Country | US
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Telephone | 601-268-5051
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Fax | 601-268-5054
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Provider Business Mailing Address
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Address Line | 109 MILLSAPS DR STE C
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City | HATTIESBURG
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State | MS
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Zip | 39402-1587
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Country | US
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Telephone | 601-268-5051
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Fax | 601-268-5054
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JERRA CHRISTINA ALLEN
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Credential |
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Telephone | 601-268-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | MS
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