Basic Information
| Provider Information | |||||||||
| NPI: | 1770830077 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DHP OF DESOTO PROFESSIONAL ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 265 BROOKVIEW CENTRE WAY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379194052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656931000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7601 SOUTHCREST PKWY | ||||||||
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| City: | SOUTHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386714739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627724000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 08/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | DABBS | ||||||||
| AuthorizedOfficialFirstName: | RANDAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8656931000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.