Provider Demographics
NPI:1396217345
Name:SNODGRASS, DAVID LEE (NP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:SNODGRASS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5001 HARDY ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1308
Mailing Address - Country:US
Mailing Address - Phone:601-268-8549
Mailing Address - Fax:601-261-5716
Practice Address - Street 1:1146 EVELYN GANDY PKWY
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-3947
Practice Address - Country:US
Practice Address - Phone:601-584-4309
Practice Address - Fax:601-584-4890
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2020-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS881470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily