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General NPI Number Information
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NPI Number | 1669542353
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN PEDIATRICS SPECIALISTS
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4290 LAKELAND DR SUITE B
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City | FLOWOOD
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State | MS
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Zip | 39232-9571
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Country | US
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Telephone | 601-638-4076
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Fax | 601-638-4979
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Provider Business Mailing Address
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Address Line | PO BOX 822394
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City | VICKSBURG
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State | MS
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Zip | 39182-2394
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Country | US
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Telephone | 601-638-4076
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Fax | 601-638-4979
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | FERMIKA SMITH
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Credential |
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Telephone | 601-638-4076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | MS
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