Provider Demographics
NPI:1508942137
Name:DEWITT, ERIN ADAM (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ADAM
Last Name:DEWITT
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 1:11163 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-9412
Mailing Address - Country:US
Mailing Address - Phone:228-586-6366
Mailing Address - Fax:
Practice Address - Street 1:4405 E ALOHA DR BLDG 1A
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3388
Practice Address - Country:US
Practice Address - Phone:228-255-8818
Practice Address - Fax:228-255-8820
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS19114207Q00000X
MS19114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09688518Medicaid