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General NPI Number Information
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NPI Number | 1639374218
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Entity Type | Organization
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Legal Business Name | STARKVILLE UROLOGY, PLLC
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 1207 HIGHWAY 182 W STE B
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City | STARKVILLE
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State | MS
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Zip | 39759-9013
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Country | US
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Telephone | 662-324-1097
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Fax | 662-324-2412
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Provider Business Mailing Address
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Address Line | 1207 HIGHWAY 182 W STE B
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City | STARKVILLE
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State | MS
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Zip | 39759-9013
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Country | US
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Telephone | 662-324-1097
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Fax | 662-324-2412
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DONACIANA INGRAM
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Credential |
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Telephone | 662-324-1097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 17324
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License Number State | MS
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