Individual
MR. TIMOTHY M. SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
332 HIGHWAY 12 W, KOSCIUSKO, MS 39090-3209
(662) 289-1800
(662) 289-2486
Mailing address
332 HIGHWAY 12 W, KOSCIUSKO, MS 39090-3209
(662) 289-1800
(662) 289-2486
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R701483
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114061
—
MS
Enumeration date
04/07/2006
Last updated
10/01/2012
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