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General NPI Number Information
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NPI Number | 1427342849
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Entity Type | Individual
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Provider Name | ANN K FAIREY M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 2400 MIMOSA LN
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City | HATTIESBURG
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State | MS
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Zip | 39402-2536
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Country | US
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Telephone | 601-268-8765
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 MIMOSA LN
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City | HATTIESBURG
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State | MS
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Zip | 39402-2536
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Country | US
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Telephone | 601-268-8765
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Fax |
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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 | MD 20135
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License Number State | SC
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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 | 14701
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J1243
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License Number State | TX
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