Organization
ORANGE GROVE MEDICAL SPECIALTIES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA LEATHERWOOD (MANAGER)
(228) 832-5151
Entity
Organization
Contact information
Practice address
15286 COMMUNITY RD, GULFPORT, MS 39503-3509
(228) 832-5151
(228) 832-6320
Mailing address
15286 COMMUNITY RD, GULFPORT, MS 39503
(228) 832-5151
(228) 832-6320
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL2948
RAILROAD MEDICARE
MS
Enumeration date
08/27/2007
Last updated
05/15/2015
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