Individual
THAD F WAITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5800
(601) 261-3530
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5800
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
06037
MS
207RI0011X
Interventional Cardiology Physician
Primary
06037
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00016544
—
MS
05
—
009907150
—
AL
01
—
060005423
RAILROAD MEDICARE
MS
05
—
1165425
—
LA
05
—
1472654
—
LA
01
—
1558986
AMERICAN ADMIN GROUP
MS
Enumeration date
08/30/2006
Last updated
07/08/2020
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