Provider Demographics
NPI:1760447056
Name:MYERS, ALICE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:MYERS
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 1:39 FRANKLIN RD
Mailing Address - Street 2:STE. 220
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1588
Mailing Address - Country:US
Mailing Address - Phone:601-296-3050
Mailing Address - Fax:
Practice Address - Street 1:39 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1588
Practice Address - Country:US
Practice Address - Phone:601-296-3050
Practice Address - Fax:601-296-3013
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06122731Medicaid
MS09016137Medicaid
MS06122731Medicaid
MS512I370029Medicare PIN