# EAR,NOSE & THROAT SURGICAL CLINIC OF SOUTH CENTRAL MS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033312772
- **Authorized official:** DR. CARL WAYNE STEVENS II M.D. (PRESIDENT)
- **Authorized official phone:** (061) 649-9706

## Contact information

- **Practice address:** 306 S 12TH AVE, LAUREL, MS 39440-4327
- **Practice address phone:** (601) 649-9706
- **Practice address fax:** (601) 649-9708
- **Mailing address:** 306 S 12TH AVE, LAUREL, MS 39440-4327
- **Mailing address phone:** (601) 649-9706
- **Mailing address fax:** (601) 649-9708

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | 15762 | MS | Yes |

## Other

- **Enumeration date:** 06/08/2007
- **Last updated:** 05/21/2008