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General NPI Number Information
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NPI Number | 1518037175
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Entity Type | Organization
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Legal Business Name | CALEB W. HERNDON, M.D., PH.D., P.A.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 347 W CHEROKEE ST
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City | BROOKHAVEN
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State | MS
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Zip | 39601-3219
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Country | US
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Telephone | 601-833-1946
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Fax | 601-833-3938
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Provider Business Mailing Address
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Address Line | 347 W CHEROKEE ST
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City | BROOKHAVEN
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State | MS
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Zip | 39601-3219
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Country | US
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Telephone | 601-833-1946
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Fax | 601-833-3938
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. NATALIE B. HERNDON
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Credential | PH.D.
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Telephone | 601-833-1946
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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 | 06643
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License Number State | MS
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