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General NPI Number Information
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NPI Number | 1255329371
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Entity Type | Individual
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Provider Name | SUTHIN SONGCHAROEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 2550 FLOWOOD DR #300
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City | FLOWOOD
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State | MS
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Zip | 39232-9303
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Country | US
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Telephone | 601-420-0034
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Fax | 601-420-5482
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Provider Business Mailing Address
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Address Line | 2 DEERFIELD DR
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City | MADISON
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State | MS
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Zip | 39110-9749
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Country | US
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Telephone | 601-856-7372
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Fax | 601-420-5482
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 07163
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License Number State | MS
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