Individual
DR. OLLIE HARDAWAY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
154 COTTONWOOD STREET, VICKSBURG, MS 39180
(662) 873-4593
(662) 873-4112
Mailing address
113 RIALTO ST, VICKSBURG, MS 39180-6030
(601) 636-0834
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
180178
MS
1223G0001X
General Practice Dentistry
180178
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660200
—
MS
Enumeration date
03/23/2007
Last updated
12/17/2007
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