Organization
SOUTHERN MEDICAL IMAGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY H GENDUSA (ADMINISTRATOR)
(601) 579-4453
Entity
Organization
Contact information
Practice address
1 LINCOLN PKWY, STE 300, HATTIESBURG, MS 39402-3262
(601) 579-4440
(601) 579-4460
Mailing address
1 LINCOLN PKWY, STE 300, HATTIESBURG, MS 39402-3262
(601) 579-6622
(601) 579-6632
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09008521
—
MS
Enumeration date
10/03/2006
Last updated
04/20/2008
Update your record
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