Organization
GENERAL SURGERY OF SOUTHAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL BENJAMIN FORE M.D. (OWNER)
(662) 536-1944
Entity
Organization
Contact information
Practice address
401 SOUTHCREST CIR, SUITE 210, SOUTHAVEN, MS 38671-6726
(662) 536-1944
(662) 536-1947
Mailing address
401 SOUTHCREST CIR, SUITE 210, SOUTHAVEN, MS 38671-6726
(662) 536-1944
(662) 536-1947
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03873250
—
MS
Enumeration date
08/17/2006
Last updated
03/24/2016
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