Provider Demographics
NPI:1205844560
Name:DANFORD, OMELIA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:OMELIA
Middle Name:ELIZABETH
Last Name:DANFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 SAINT ANNES DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-8253
Mailing Address - Country:US
Mailing Address - Phone:601-342-1411
Mailing Address - Fax:
Practice Address - Street 1:82 SAINT ANNES DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8253
Practice Address - Country:US
Practice Address - Phone:601-342-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1559186OtherAMERICAN ADMIN GROUP
MS00122376Medicaid
MS1559186OtherAMERICAN ADMIN GROUP
G84232Medicare UPIN
MS080003335Medicare PIN