Individual
KELLY KOZIOL WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
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
242T00000X
Perfusionist
Primary
040030
MS
Other
Enumeration date
04/03/2007
Last updated
08/23/2016
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