# MEDICAL FOUNDATION OF SOUTH MISSISSIPPI

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Weaver Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801904156
- **Authorized official:** MR. RANDY ROBINSON (ADMINISTRATOR)
- **Authorized official phone:** (228) 865-1453

## Contact information

- **Practice address:** 1612 31ST AVE, GULFPORT, MS 39501-2750
- **Practice address phone:** (228) 865-1453
- **Practice address fax:** (228) 865-1451
- **Mailing address:** 1612 31ST AVE, GULFPORT, MS 39501-2750
- **Mailing address phone:** (228) 865-1453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 14403 | MS | Yes |

## Other

- **Enumeration date:** 08/28/2006
- **Last updated:** 02/01/2008