Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 959 | MS |
Y | 213ER0200X | Radiology | 959 | MS |
NPI | 1083752646 |
---|---|
Provider Name | Dr. Marla Vaden Hinckley |
First Address | Mccomb, MS 39648 |
Second Address | Mccomb, MS 39648-3620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 22/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00120127 | (05) | MS |