Organization
ST MICHAELS URGENT CARE OF HATTIESBURG
Active
Parent organization
INLAND FAMILY PRACTICE CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
INLAND FAMILY PRACTICE CENTER
Authorized official
MARVA JOYCE COOLEY CPC (CREDENTIALLING DIRECTOR)
(601) 909-2539
Entity
Organization
Contact information
Practice address
3700 HARDY ST, HATTIESBURG, MS 39402-1610
(601) 602-2014
(601) 602-2015
Mailing address
3700 HARDY ST, HATTIESBURG, MS 39402-1610
(601) 602-2014
(601) 602-2015
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
363LF0000X
Family Nurse Practitioner
Primary
R875464
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00776879
—
MS
Enumeration date
12/02/2013
Last updated
09/06/2016
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