Organization
MISISSIPPI PROVIDENCE HEALTHCARE SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARK P. CHRISTIANSON (PRESIDENT)
(251) 631-3574
Entity
Organization
Contact information
Practice address
5907 HIGHWAY 90, MOSS POINT, MS 39563-6536
(228) 769-2611
(228) 762-1638
Mailing address
PO BOX 850489, MOBILE, AL 36685-0489
(251) 342-3949
(251) 631-3361
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
AL
Other
Enumeration date
09/13/2012
Last updated
01/22/2013
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