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General NPI Number Information
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NPI Number | 1386979961
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Entity Type | Organization
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Legal Business Name | SOUTH MISSISSIPPI EAR, NOSE AND THROAT
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 2525 TELEPHONE ROAD
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City | PASCAGOULA
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State | MS
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Zip | 39567
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Country | US
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Telephone | 228-762-4483
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Fax | 228-769-0406
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Provider Business Mailing Address
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Address Line | 2525 TELEPHONE ROAD
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City | PASCAGOULA
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State | MS
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Zip | 39567
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Country | US
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Telephone | 228-762-4483
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Fax | 228-769-0406
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Authorized Official
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Title or Position | CEO
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Name | MR. DONALD S DAVENPORT
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Credential |
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Telephone | 228-762-4483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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