Organization
DESOTO EAR, NOSE &THROAT
Active
Organization
DESOTO EAR, NOSE &THROAT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREENE BERRY COLVIN MD (OWNER)
(662) 895-6455
Entity
Organization
Contact information
Practice address
7164 HACKS CROSS RD STE 106, OLIVE BRANCH, MS 38654-3919
(662) 895-6455
(662) 895-6460
Mailing address
7164 HACKS CROSS RD STE 106, OLIVE BRANCH, MS 38654-3919
(662) 895-6455
(662) 895-6460
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016063
—
MS
Enumeration date
09/27/2006
Last updated
06/09/2020
Update your record
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