NPI:
1629022017
Provider Name:
MMO OF HATTIESBURG, LLC
Former Legal Business Name: DELTA MEDICAL SYSTEMS, LLC
Classification:
Clinic/Center - 261QM0801X
Entity Type:
Organization
Specialization: Mental Health (Including Community Mental Health Center)
Address:
990 HARDY ST
SUITE 4
HATTIESBURG, MS
ZIP 39401
Phone:
(601) 602-0194
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MMO OF HATTIESBURG, LLC is a mental health (including community mental health center) clinic center in Hattiesburg, MS. MMO OF HATTIESBURG, LLC NPI is 1629022017. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Delta Medical Systems, Llc.
The provider's business location address is:
990 HARDY ST
SUITE 4
HATTIESBURG, MS
ZIP 39401-161
Phone: (601) 602-0194
Fax: (601) 602-0197
The provider's authorized official is Robert L. Miller .
The authorized official title is Ceo and has the following contact phone number (225) 293-6774.
The enumeration date for this NPI number is 5/20/2006 and was last updated on 7/2/2010.