Provider Demographics
NPI:1205997251
Name:GROW, CHELSEA R (DO)
Entity type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:R
Last Name:GROW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-867-4855
Mailing Address - Fax:228-867-4870
Practice Address - Street 1:1340 BROAD AVENUE
Practice Address - Street 2:STE 440
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-867-4855
Practice Address - Fax:228-867-4870
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS190222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07985779Medicaid
MS$$$$$$$$$OtherBCBS
MS130000281Medicare ID - Type Unspecified
MS07985779Medicaid
MS302I135926Medicare PIN
MS512I130041Medicare PIN