Provider Demographics
NPI:1164696951
Name:COMPTON, ASTRID (MD ON MAY 08)
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:
Last Name:COMPTON
Suffix:
Gender:F
Credentials:MD ON MAY 08
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 U S HIGHWAY 98 STE 140
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8557
Mailing Address - Country:US
Mailing Address - Phone:601-450-1816
Mailing Address - Fax:601-450-1817
Practice Address - Street 1:7100 U S HIGHWAY 98 STE 140
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8557
Practice Address - Country:US
Practice Address - Phone:601-450-1816
Practice Address - Fax:601-450-1817
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24121208000000X
IL036-132138208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00333823Medicaid