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General NPI Number Information
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NPI Number | 1598879009
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Entity Type | Organization
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Legal Business Name | DIGESTIVE DISEASES CENTER OF HATTIESBURG, LLC
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 1000 TURTLE CREEK DR STE 4
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City | HATTIESBURG
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State | MS
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Zip | 39402-1173
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Country | US
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Telephone | 601-268-5189
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Fax | 601-268-5006
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Provider Business Mailing Address
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Address Line | 100 METHODIST HOSPITAL BLVD
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City | HATTIESBURG
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State | MS
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Zip | 39402-1295
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Country | US
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Telephone | 601-268-5189
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Fax | 601-268-5006
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEPHEN E BUCKLEY
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Credential | M.D.
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Telephone | 601-268-5189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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