Provider Demographics
NPI:1760921316
Name:BATES, SOKHEN
Entity Type:Individual
Prefix:
First Name:SOKHEN
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 PEARL RIVER AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-8646
Mailing Address - Country:US
Mailing Address - Phone:601-600-6559
Mailing Address - Fax:
Practice Address - Street 1:100 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2826
Practice Address - Country:US
Practice Address - Phone:601-600-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care