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General NPI Number Information
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NPI Number | 1902814361
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Entity Type | Individual
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Provider Name | KENNETH RAY DAUGHTREY JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 701 S HOLLY AVE
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City | COLLINS
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State | MS
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Zip | 39428-3894
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Country | US
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Telephone | 601-765-6711
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Fax | 601-698-0186
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | SEMINARY
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State | MS
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Zip | 39479-0055
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Country | US
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Telephone | 601-506-7468
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Fax | 601-429-9403
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 11516
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License Number State | MS
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