Organization
SMB RADIOLOGY P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLIFTON T LEATHERBURY MD (PRESIDENT)
(228) 762-1353
Entity
Organization
Contact information
Practice address
1365 MARKET ST, PASCAGOULA, MS 39567-6604
(228) 762-1353
(228) 762-1359
Mailing address
PO BOX 749627, ATLANTA, GA 30374-9627
(866) 264-3435
(706) 596-6704
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014149
—
MS
Enumeration date
08/03/2005
Last updated
01/17/2025
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