Provider Demographics
NPI:1750600102
Name:BROOKHAVEN RADIOLOGY PLLC
Entity type:Organization
Organization Name:BROOKHAVEN RADIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:SONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-948-2105
Mailing Address - Street 1:PO BOX 3867
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39603-7867
Mailing Address - Country:US
Mailing Address - Phone:601-948-2105
Mailing Address - Fax:
Practice Address - Street 1:427 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2350
Practice Address - Country:US
Practice Address - Phone:601-948-2105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS195122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty