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Organization
HISTOLOGY CYTOLOGY TECHNICAL LAB OF NORTH MISSISSIPPI
Active
Organization
HISTOLOGY CYTOLOGY TECHNICAL LAB OF NORTH MISSISSIPPI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN P FULLENWIDER M.D. (SOLE PROPRIETOR)
(800) 362-0858
Entity
Organization
Contact information
Practice address
2301 S LAMAR BLVD, OXFORD, MS 38655-5373
(662) 232-8121
(662) 236-5236
Mailing address
PO BOX 428, OXFORD, MS 38655-0428
(662) 232-8121
(662) 236-5236
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
11854
MS
Other
Enumeration date
11/17/2008
Last updated
12/03/2008
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