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General NPI Number Information
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NPI Number | 1891325015
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Entity Type | Individual
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Provider Name | JOSEPH ANTHONY COURSEY
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Gender | Male
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 1721 29TH AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2848
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Country | US
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Telephone | 228-284-0446
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Fax | 228-284-0454
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Provider Business Mailing Address
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Address Line | 1721 29TH AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2848
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Country | US
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Telephone | 228-284-0446
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Fax | 228-284-0454
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 15185
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License Number State | MS
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