Provider Demographics
NPI:1093278582
Name:HATTIESBURG MUSCULOSKELETAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:HATTIESBURG MUSCULOSKELETAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:DANJACK
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-520-7012
Mailing Address - Street 1:23 WINDSTONE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1254
Mailing Address - Country:US
Mailing Address - Phone:601-520-7012
Mailing Address - Fax:
Practice Address - Street 1:23 WINDSTONE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1254
Practice Address - Country:US
Practice Address - Phone:601-336-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty