Individual
CHARLES R BRENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1212 SOUTH 28TH AVE, HATTIESBURG, MS 39402
(601) 475-2430
Mailing address
1212 SOUTH 28TH AVE, HATTIESBURG, MS 39402
(601) 475-2430
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
09082
MS
207T00000X
Neurological Surgery Physician
9082
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0113775
—
MS
Enumeration date
09/25/2006
Last updated
03/28/2022
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