Organization
SOUTH MISSISSIPPI NEUROSURGICAL SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES R. BRENT MD (OWNER/PHYSICIAN)
(601) 579-4440
Entity
Organization
Contact information
Practice address
1212 SOUTH 28TH AVE, HATTIESBURG, MS 39402
(601) 475-2430
Mailing address
1212 SOUTH 28TH AVE, HATTIESBURG, MS 39402-3261
(601) 579-4440
(601) 579-4458
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
09082
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09082
MS LICENSE
MS
Enumeration date
02/27/2017
Last updated
06/12/2018
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