Organization
GOOD SAMARITAN PEDIATRICS SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FERMIKA SMITH (BUSINESS MANAGER)
(601) 638-4076
Entity
Organization
Contact information
Practice address
4290 LAKELAND DR, SUITE B, FLOWOOD, MS 39232-9571
(601) 638-4076
(601) 638-4979
Mailing address
PO BOX 822394, VICKSBURG, MS 39182-2394
(601) 638-4076
(601) 638-4979
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03675793
—
MS
Enumeration date
11/09/2006
Last updated
07/21/2022
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