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General NPI Number Information
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NPI Number | 1619920584
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Entity Type | Organization
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Legal Business Name | PAIN CONSULTANTS OF SOUTH MISSISSIPPI PA
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 106 ASBURY CIR
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City | HATTIESBURG
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State | MS
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Zip | 39402-1302
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Country | US
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Telephone | 601-268-8698
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Fax | 601-296-3049
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Provider Business Mailing Address
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Address Line | 106 ASBURY CIRCLE
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City | HATTIESBURG
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State | MS
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Zip | 39402-0000
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Country | US
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Telephone | 601-268-8698
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Fax | 601-296-3049
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Authorized Official
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Title or Position | CEO/MEDICAL DIRECTOR
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Name | DR. DAVID L MCKELLAR
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Credential | MD
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Telephone | 601-268-8698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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