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General NPI Number Information
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NPI Number | 1639878119
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Entity Type | Organization
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Legal Business Name | SJ SURGICAL ASSISTING, LLC
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 111 COMANCHE DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-2403
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Country | US
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Telephone | 601-604-2858
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Fax |
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Provider Business Mailing Address
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Address Line | 111 COMANCHE DR
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City | HATTIESBURG
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State | MS
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Zip | 39402-2403
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Country | US
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Telephone | 601-604-2858
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Fax |
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Authorized Official
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Title or Position | CERTIFIED SURGICAL FIRST ASSIST
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Name | STACEY RENAE JOYNER
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Credential | CSFA
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Telephone | 601-604-2858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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