Organization
HEALTH FACILITY LABORATORY
Active
Other names
Pine Grove Behavioral Health, PMGROUP
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB PARKER MD (REGISTERD NURSE)
(601) 329-1321
Entity
Organization
Contact information
Practice address
300 FAIRWAY DR, HATTIESBURG, MS 39401-7715
(601) 329-1321
Mailing address
300 FAIRWAY DR, HATTIESBURG, MS 39401-7715
(601) 329-1321
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
347C00000X
Private Vehicle
—
—
347D00000X
Train
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MS0800375
LABORATORY
MS
Enumeration date
02/02/2021
Last updated
05/06/2024
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