Individual
KELLY R O'NEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
421 S 28TH AVE, HATTIESBURG, MS 39401-7236
(601) 268-5640
(601) 261-3507
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5640
(601) 261-3507
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
06447
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00016764
—
MS
05
—
1536598
—
LA
01
—
2292727
AMERICAN ADMIN GROUP
MS
Enumeration date
08/21/2006
Last updated
03/27/2009
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