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General NPI Number Information
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NPI Number | 1871767830
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Entity Type | Organization
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Legal Business Name | LAWRENCE M. SLOCKI, MD
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Dates
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Enumeration Date | 04/21/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 517 5TH AVE
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City | PICAYUNE
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State | MS
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Zip | 39466-3203
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Country | US
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Telephone | 601-798-1512
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Fax | 601-798-0448
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Provider Business Mailing Address
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Address Line | PO BOX 490
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City | PICAYUNE
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State | MS
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Zip | 39466-0490
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Country | US
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Telephone | 601-798-1512
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Fax | 601-798-0448
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE M. SLOCKI
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Credential | MD
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Telephone | 601-798-1512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 10968
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License Number State | MS
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