=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881491850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WAVERLY DANIELLE MCSWAIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6098 US 98 HWY E SUITE 60
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-588-5882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 CROSS CREEK PKWY APT 1104
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39402-4441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-307-3952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246Z00000X
-----------------------------------------------------
Taxonomy Name | Other Specialist/Technologist
-----------------------------------------------------
License Number | TA-2981
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------