Provider Demographics
NPI:1215137096
Name:STEVENS, DANIEL GREGORY (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:GREGORY
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15722
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-5722
Mailing Address - Country:US
Mailing Address - Phone:601-288-1823
Mailing Address - Fax:601-288-1877
Practice Address - Street 1:1842 SIMPSON HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3438
Practice Address - Country:US
Practice Address - Phone:601-847-2424
Practice Address - Fax:601-847-2199
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine