# ORANGE GROVE MEDICAL SPECIALTIES, P.A.

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

## Provider details

- **NPI number:** 1295928893
- **Authorized official:** LISA LEATHERWOOD (MANAGER)
- **Authorized official phone:** (228) 832-5151

## Contact information

- **Practice address:** 15286 COMMUNITY RD, GULFPORT, MS 39503-3509
- **Practice address phone:** (228) 832-5151
- **Practice address fax:** (228) 832-6320
- **Mailing address:** 15286 COMMUNITY RD, GULFPORT, MS 39503
- **Mailing address phone:** (228) 832-5151
- **Mailing address fax:** (228) 832-6320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/27/2007
- **Last updated:** 05/15/2015