Organization
COASTAL PREVENTATIVE MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY MONDAY (ADMIN)
(601) 296-2552
Entity
Organization
Contact information
Practice address
3300 LADNIER RD, GAUTIER, MS 39553-5909
(228) 497-2652
(228) 497-3667
Mailing address
PO BOX 17708, HATTIESBURG, MS 39404-7708
(601) 296-2552
(601) 296-2397
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
MS
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
05/04/2011
Last updated
05/04/2011
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