Organization
SOUTHERN MEDICAL IMAGING
Active
Organization
SOUTHERN MEDICAL IMAGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY GENDUSA (OFFICE MANAGER)
(601) 579-4500
Entity
Organization
Contact information
Practice address
1 LINCOLN PKWY, SUITE 105, HATTIESBURG, MS 39402-3262
(601) 579-4463
Mailing address
1 LINCOLN PKWY, SUITE 105, HATTIESBURG, MS 39402-3262
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09008521
—
MS
Enumeration date
10/16/2008
Last updated
10/16/2008
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