Provider Demographics
NPI:1285857623
Name:SOUTH MISSISSIPPI NEPHROLOGY, PLLC
Entity Type:Organization
Organization Name:SOUTH MISSISSIPPI NEPHROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:228-863-7393
Mailing Address - Street 1:4300B W RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2568
Mailing Address - Country:US
Mailing Address - Phone:228-863-7393
Mailing Address - Fax:228-864-0546
Practice Address - Street 1:784 VIEUX MARCHE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530
Practice Address - Country:US
Practice Address - Phone:228-374-7525
Practice Address - Fax:228-864-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02221Medicare PIN