Individual
MELVIN L SELF JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1401 RIVER RD, GREENWOOD, MS 38930-4030
(662) 459-2613
(662) 459-1159
Mailing address
PO BOX 1410, GREENWOOD, MS 38935-1410
(662) 459-2613
(662) 459-1159
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R855594
MS
Other
Enumeration date
12/20/2007
Last updated
12/20/2007
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