Organization
HANCOCK FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD KELLUM MD (MD OWNER)
(228) 586-9229
Entity
Organization
Contact information
Practice address
5400 INDIAN HILL BLVD, DIAMONDHEAD, MS 39525-3334
(228) 586-9229
(228) 586-9230
Mailing address
5400 INDIAN HILL BLVD, DIAMONDHEAD, MS 39525-3334
(228) 586-9229
(228) 586-9230
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C93454
MEDICARE ID
MS
Enumeration date
08/28/2006
Last updated
11/26/2007
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