# KENNETH HINES MD PA

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

## Provider details

- **NPI number:** 1972689321
- **Authorized official:** KENNETH LEE HINES MD (PRESIDENT 100 PERCENT STOCKHOLDER)
- **Authorized official phone:** (662) 455-1442

## Contact information

- **Practice address:** 408 W MARKET ST, GREENWOOD, MS 38930
- **Practice address phone:** (662) 455-1442
- **Practice address fax:** (662) 455-6065
- **Mailing address:** 408 W MARKET ST, GREENWOOD, MS 38930
- **Mailing address phone:** (662) 455-1442
- **Mailing address fax:** (662) 455-6065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 08354 | MS | Yes |

## Other

- **Enumeration date:** 10/28/2006
- **Last updated:** 11/07/2007