Individual
PHILLIP MATTHEW EZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC, AGACNP-BC
Contact information
Practice address
908 S GEORGE AVE, PETAL, MS 39465-2077
(601) 544-7441
Mailing address
670 WEATHERSBY RD STE 140, HATTIESBURG, MS 39402-9586
(601) 318-0669
(601) 994-6001
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
905839
MS
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
905839
MS
Other
Enumeration date
09/28/2023
Last updated
01/05/2026
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