Provider Demographics
NPI:1497464838
Name:ABHA MISHRA NEUROLOGY PLLC
Entity Type:Organization
Organization Name:ABHA MISHRA NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-596-1270
Mailing Address - Street 1:753 E SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-4620
Mailing Address - Country:US
Mailing Address - Phone:228-596-1270
Mailing Address - Fax:
Practice Address - Street 1:1340 BROAD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2404
Practice Address - Country:US
Practice Address - Phone:228-596-1103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty