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General NPI Number Information
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NPI Number | 1407019375
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Entity Type | Individual
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Provider Name | ANDREA F LOGAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 1129 OCEAN SPRINGS RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3421
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Country | US
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Telephone | 228-818-5008
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Fax | 228-818-5012
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Provider Business Mailing Address
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Address Line | 1129 OCEAN SPRINGS RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3421
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Country | US
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Telephone | 228-818-5008
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Fax | 228-818-5012
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | AU5009697 1339
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 21719
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License Number State | MS
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