Provider Demographics
NPI:1699921197
Name:THE PEDIATRIC NEUROLOGY CLINIC OF HATTIESBURG
Entity type:Organization
Organization Name:THE PEDIATRIC NEUROLOGY CLINIC OF HATTIESBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-296-3050
Mailing Address - Street 1:5003 HARDY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1331
Mailing Address - Country:US
Mailing Address - Phone:601-296-3050
Mailing Address - Fax:601-296-3060
Practice Address - Street 1:5003 HARDY ST STE 200
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1331
Practice Address - Country:US
Practice Address - Phone:601-296-3050
Practice Address - Fax:601-296-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty