Organization
GARDEN PARK PHYSICIAN SERVICES CORP
Active
Other names
Joseph L. Faison, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LAGESSE (VP)
(866) 653-0021
Entity
Organization
Contact information
Practice address
1924 30TH AVE, GULFPORT, MS 39501-4534
(228) 832-2004
(228) 832-4093
Mailing address
1924 30TH AVE, GULFPORT, MS 39501-4534
(228) 832-2004
(228) 832-4093
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016021
—
MS
01
—
J5628
RR MEDICARE
MS
Enumeration date
10/09/2007
Last updated
10/10/2007
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