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General NPI Number Information
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NPI Number | 1770705170
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Entity Type | Organization
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Legal Business Name | SOUTH PIKE
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 444 AMITE STREET
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City | OSYKA
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State | MS
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Zip | 39657
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Country | US
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Telephone | 601-542-3354
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Fax |
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Provider Business Mailing Address
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Address Line | 444 AMITE STREET
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City | OSYKA
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State | MS
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Zip | 39657
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Country | US
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Telephone | 601-542-3354
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Fax |
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Authorized Official
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Title or Position | DISTRICT SUPERINTENDENT
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Name | DR. BILL GUNNELL
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Credential |
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Telephone | 601-783-3742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | R868937
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License Number State | MS
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