Individual
THOMAS G PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1107 S 34TH AVE, HATTIESBURG, MS 39402-3004
(601) 268-1988
Mailing address
1107 S 34TH AVE, HATTIESBURG, MS 39402-3004
(601) 268-1988
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
06231
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120180
—
MS
05
—
009924610
—
AL
01
—
1559101
AMERICAN ADMIN GROUP
MS
05
—
1561274
—
LA
Enumeration date
08/27/2006
Last updated
08/03/2022
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