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General NPI Number Information
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NPI Number | 1811171648
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Entity Type | Organization
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Legal Business Name | SOUTH MISSISSIPPI NEPHROLOGY
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 12/28/2007
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Provider Practice Location Address
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Address Line | 4405 E ALOHA DR STE I
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-3380
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Country | US
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Telephone | 228-863-7393
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Fax | 228-864-0546
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Provider Business Mailing Address
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Address Line | 4300B W RAILROAD ST
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-863-7393
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Fax | 228-864-0546
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DOUGLAS C LANIER JR.
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Credential | M.D.
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Telephone | 228-863-7393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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