Provider Demographics
NPI:1295151850
Name:MARY A. DOSS
Entity type:Organization
Organization Name:MARY A. DOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-594-3352
Mailing Address - Street 1:110 NAPOLEON DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-9004
Mailing Address - Country:US
Mailing Address - Phone:601-594-3352
Mailing Address - Fax:
Practice Address - Street 1:110 NAPOLEON DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-9004
Practice Address - Country:US
Practice Address - Phone:601-594-3352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========Medicaid