Basic Information
| Provider Information | |||||||||
| NPI: | 1841416070 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEAD & NECK SURGICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5345 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392965345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019325244 | ||||||||
| FaxNumber: | 6019390545 | ||||||||
| Practice Location | |||||||||
| Address1: | 1038 RIVER OAKS DRIVE | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019325244 | ||||||||
| FaxNumber: | 6019390545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 06/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | CORING | ||||||||
| AuthorizedOfficialFirstName: | PHRONIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6019325244 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.