Organization
PAIN TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID L MCKELLAR MD (CEO/MEDICAL DIRECTOR)
(601) 268-8698
Entity
Organization
Contact information
Practice address
106 ASBURY CIR, HATTIESBURG, MS 39402-1302
(601) 268-8698
Mailing address
106 ASBURY CIRCLE, HATTIESBURG, MS 39402
(601) 268-8698
(601) 296-3049
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770530
—
MS
01
—
25C0001032
ASC ID NUMBER
MS
Enumeration date
12/29/2006
Last updated
01/20/2011
Update your record
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