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Organization

BROOKHAVEN SURGERY CLINIC P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID VANCE CARNER M.D. (PRESIDENT)
(601) 835-1182
Entity
Organization

Contact information

Practice address
1036 D A BIGLANE DR, BROOKHAVEN, MS 39601-2331
(601) 835-1182
(601) 835-1546
Mailing address
1036 D A BIGLANE DR, BROOKHAVEN, MS 39601-2331
(601) 835-1182
(601) 835-1546

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09013622
MS
01
CM2256
RAILROAD MEDICARE
MS
Enumeration date
10/05/2006
Last updated
05/20/2008
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