Organization
MISSISSIPPI STATE DEPARTMENT OF HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA DAVIS (ADMINISTRATOR)
(228) 762-1117
Entity
Organization
Contact information
Practice address
4600 VEGA ST, PASCAGOULA, MS 39581-5303
(228) 762-1117
Mailing address
4600 VEGA ST, PASCAGOULA, MS 39581-5303
Taxonomy
Speciality
Code
Description
License number
State
261QA0005X
Ambulatory Family Planning Facility
Primary
R863092
MS
Other
Enumeration date
11/01/2010
Last updated
11/01/2010
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