Organization
REGION XII COMMISSION
Active
Other names
Pine Belt Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY MAYO (EXECUTIVE DIRECTOR)
(601) 544-4641
Entity
Organization
Contact information
Practice address
934 WEST DR, LAUREL, MS 39440-4702
(601) 426-7520
Mailing address
PO BOX 18679, HATTIESBURG, MS 39404-8679
(601) 705-1902
(601) 705-1952
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/09/2010
Last updated
08/09/2010
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