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Individual

ANN K FAIREY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2400 MIMOSA LN, HATTIESBURG, MS 39402-2536
(601) 268-8765
Mailing address
2400 MIMOSA LN, HATTIESBURG, MS 39402-2536
(601) 268-8765

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
14701
MS
208000000X
Pediatrics Physician
J1243
TX
208000000X
Pediatrics Physician
MD 20135
SC

Other

Enumeration date
06/02/2011
Last updated
06/02/2011
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