Organization
SOUTHERN MS PLANNING AND DEVELOPMENT DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOROTHY WALLEY RN (MEDICAID WAIVER SUPERVISOR)
(228) 314-1475
Entity
Organization
Contact information
Practice address
9229 HWY 49, GULFPORT, MS 39503
(228) 868-2311
(228) 868-2550
Mailing address
9229 HWY 49, GULFPORT, MS 39503
(228) 868-2311
(228) 863-2550
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770319
—
MS
Enumeration date
10/04/2006
Last updated
08/22/2020
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