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General NPI Number Information
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NPI Number | 1659549681
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Entity Type | Individual
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Provider Name | MICHAEL C MATTINGLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 803 LIBERTY RD
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City | FLOWOOD
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State | MS
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Zip | 39232-9000
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Country | US
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Telephone | 601-714-1967
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Fax | 601-714-1966
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Provider Business Mailing Address
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Address Line | 803 LIBERTY RD
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City | FLOWOOD
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State | MS
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Zip | 39232-9000
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Country | US
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Telephone | 601-714-1967
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Fax | 601-714-1966
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 26254
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 26254
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License Number State | MS
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