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General NPI Number Information
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NPI Number | 1962845438
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Entity Type | Organization
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Legal Business Name | JOSEPH SALLOUM, M.D. LLC
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 301 S 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7233
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Country | US
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Telephone | 601-288-1701
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Fax | 601-288-1715
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Provider Business Mailing Address
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Address Line | PO BOX 15158
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City | HATTIESBURG
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State | MS
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Zip | 39404-5158
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Country | US
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Telephone | 601-288-1701
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Fax | 601-288-1715
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Authorized Official
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Title or Position | BILLING ADMINISTRATOR
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Name | KATHY FUNK
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Credential |
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Telephone | 877-434-2035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 11850
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License Number State | MS
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