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General NPI Number Information
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NPI Number | 1437529195
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Entity Type | Organization
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Legal Business Name | GENERATIONS OBSTETRICAL AND GYNECOLOGICAL CLINIC OF THE GULF COAST, LL
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 4502 OLD PASS RD
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City | GULFPORT
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State | MS
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Zip | 39501-2585
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Country | US
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Telephone | 228-861-7503
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Fax |
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Provider Business Mailing Address
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Address Line | 4502 OLD PASS RD
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City | GULFPORT
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State | MS
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Zip | 39501-2585
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD K GADDY
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Credential | M.D.
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Telephone | 228-861-7503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | MS
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