Individual
DR. SUTHIN SONGCHAROEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2550 FLOWOOD DR, #300, FLOWOOD, MS 39232-9303
(601) 420-0034
(601) 420-5482
Mailing address
2 DEERFIELD DR, MADISON, MS 39110-9749
(601) 856-7372
(601) 420-5482
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
07163
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119405
—
MS
01
—
660002223
MEDICARE RAILROAD
—
01
—
C03036
MEDICARE PTAN
—
01
—
CK7048
MEDICARE RAILROAD GROUP
—
Enumeration date
10/12/2005
Last updated
08/11/2009
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