Organization
CALEB W. HERNDON, M.D., PH.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATALIE B. HERNDON PH.D. (SECRETARY)
(601) 833-1946
Entity
Organization
Contact information
Practice address
347 W CHEROKEE ST, BROOKHAVEN, MS 39601-3219
(601) 833-1946
(601) 833-3938
Mailing address
347 W CHEROKEE ST, BROOKHAVEN, MS 39601-3219
(601) 833-1946
(601) 833-3938
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
06643
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00015595
—
MS
05
—
1629804
—
LA
01
—
462669093
BCBS OF MISSISSIPPI
MS
Enumeration date
11/09/2006
Last updated
04/22/2008
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