Provider Demographics
NPI:1104374750
Name:GREGORY A. AUZENNE MD, PA
Entity Type:Organization
Organization Name:GREGORY A. AUZENNE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:AUZENNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-286-5477
Mailing Address - Street 1:P O BOX 649107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75264
Mailing Address - Country:US
Mailing Address - Phone:601-286-5477
Mailing Address - Fax:601-286-5825
Practice Address - Street 1:4803 29TH AVE STE A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2675
Practice Address - Country:US
Practice Address - Phone:601-286-5477
Practice Address - Fax:601-286-5425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20220207LH0002X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative MedicineGroup - Multi-Specialty