Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 16507 | MS |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 16507 | MS |
NPI | 1922069921 |
---|---|
Provider Name | Curtis Scott Childress |
First Address | Hattiesburg, MS 39402-1348 |
Second Address | Hattiesburg, MS 39402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 25/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007270080 | (05) | MS |
H98381 | (02) |