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General NPI Number Information
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NPI Number | 1790974111
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Entity Type | Organization
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Legal Business Name | CHILDREN'S MEDICAL CENTER
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 15465 OAK LN SUITE 100 F
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City | GULFPORT
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State | MS
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Zip | 39503-2663
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Country | US
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Telephone | 228-832-0414
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Fax | 228-832-8227
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Provider Business Mailing Address
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Address Line | 15465 OAK LN SUITE 100 F
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City | GULFPORT
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State | MS
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Zip | 39503-2663
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Country | US
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Telephone | 228-832-0414
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Fax | 228-832-8227
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. FAUZIA F. QUDDUS
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Credential | M.D.
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Telephone | 228-832-0414
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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 | 14692
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License Number State | MS
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