Provider Demographics
NPI:1487762787
Name:PICKERING, BILLY MACK (MD)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:MACK
Last Name:PICKERING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-722-4300
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:215 BOBBY BEASLEY ST
Practice Address - Street 2:
Practice Address - City:SEMINARY
Practice Address - State:MS
Practice Address - Zip Code:39479-5501
Practice Address - Country:US
Practice Address - Phone:601-722-4300
Practice Address - Fax:601-722-9751
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1559064OtherAMERICAN ADMIN GROUP
LA1992186Medicaid
MS00117804Medicaid
MS1559064OtherAMERICAN ADMIN GROUP
MS1559064OtherAMERICAN ADMIN GROUP
MS080002936Medicare PIN