Provider Demographics
NPI:1326389651
Name:OB-GYN GROUP OF HATTIESBURG, LLC
Entity Type:Organization
Organization Name:OB-GYN GROUP OF HATTIESBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLYNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-543-8989
Mailing Address - Street 1:105 ASBURY CIR
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1397
Mailing Address - Country:US
Mailing Address - Phone:601-543-8989
Mailing Address - Fax:601-510-5537
Practice Address - Street 1:105 ASBURY CIR
Practice Address - Street 2:SUITE A-2
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1397
Practice Address - Country:US
Practice Address - Phone:601-543-8989
Practice Address - Fax:601-510-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07304207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty