Provider Demographics
NPI:1629264544
Name:COLE, ALAN KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KEVIN
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 LINCOLN PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3262
Mailing Address - Country:US
Mailing Address - Phone:601-579-4440
Mailing Address - Fax:601-579-4460
Practice Address - Street 1:1 LINCOLN PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3262
Practice Address - Country:US
Practice Address - Phone:601-579-4440
Practice Address - Fax:601-579-4460
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS212762084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I139646OtherMEDICARE
MS04556055Medicaid