Organization
PAUL D. COTTEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUZIE LASSITER (DIRECTOR OF FACILITY)
(601) 477-9384
Entity
Organization
Contact information
Practice address
1101 HIGHWAY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-9384
(601) 477-5700
Mailing address
1101 HIGHWAY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-9384
(601) 477-5700
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
233
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00023090
—
MS
Enumeration date
12/01/2006
Last updated
08/22/2020
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