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General NPI Number Information
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NPI Number | 1639620560
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Entity Type | Organization
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Legal Business Name | NORTH PLANTATION
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Dates
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Enumeration Date | 10/15/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1613 23RD AVENUE
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-284-4651
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Fax | 228-284-4636
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Provider Business Mailing Address
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Address Line | 1613 23RD AVENUE
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-224-4651
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Fax | 228-284-4636
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN ANDREW HAMMOCK
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Credential | M.D.
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Telephone | 228-284-4651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 21689
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License Number State | MS
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