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Organization
HEALTH FACILITY LABORATORY
Active
Organization
HEALTH FACILITY LABORATORY
Active
Other names
Pine Grove Behavioral Health, PMGROUP
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB PARKER MD (REGISTERD NURSE)
(601) 329-1321
Entity
Organization
Contact information
Practice address
300 FAIRWAY DR, HATTIESBURG, MS 39401-7715
(601) 329-1321
Mailing address
300 FAIRWAY DR, HATTIESBURG, MS 39401-7715
(601) 329-1321
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
347C00000X
Private Vehicle
—
NULL
347D00000X
Train
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MS0800375
LABORATORY
MS
Enumeration date
02/02/2021
Last updated
05/06/2024
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