# HEALTH FACILITY LABORATORY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pine Grove Behavioral Health, PMGROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699366542
- **Authorized official:** JACOB PARKER MD (REGISTERD NURSE)
- **Authorized official phone:** (601) 329-1321

## Contact information

- **Practice address:** 300 FAIRWAY DR, HATTIESBURG, MS 39401-7715
- **Practice address phone:** (601) 329-1321
- **Mailing address:** 300 FAIRWAY DR, HATTIESBURG, MS 39401-7715
- **Mailing address phone:** (601) 329-1321

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 347C00000X | Private Vehicle | — | NULL | — |
| 347D00000X | Train | — | NULL | — |

## Other

- **Enumeration date:** 02/02/2021
- **Last updated:** 05/06/2024