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General NPI Number Information
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NPI Number | 1861507311
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Entity Type | Organization
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Legal Business Name | EAR, NOSE & THROAT PHYSICIANS OF NORTH MISS., P.A.
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 618 PEGRAM DR
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City | TUPELO
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State | MS
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Zip | 38801-6322
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Country | US
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Telephone | 662-844-6513
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Fax | 662-844-1113
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Provider Business Mailing Address
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Address Line | PO BOX 2180
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City | TUPELO
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State | MS
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Zip | 38803-2180
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Country | US
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Telephone | 662-844-6513
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Fax | 662-844-1113
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES MONTGOMERY BERRY
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Credential | M.D.
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Telephone | 662-844-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | MS
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