Individual
ANUTIDA CHAROENTONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
102 SHELBY SPEIGHTS DR, PURVIS, MS 39475-4151
(601) 794-8065
(601) 794-5650
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5444
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27867
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03553252
—
MS
Enumeration date
04/27/2017
Last updated
01/31/2022
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