Provider Demographics
NPI:1174614325
Name:SPINAL & NEUROLOGICAL SURGERY OF SOUTH MISSISSIPPI PLLC
Entity type:Organization
Organization Name:SPINAL & NEUROLOGICAL SURGERY OF SOUTH MISSISSIPPI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-631-2229
Mailing Address - Street 1:15190 COMMUNITY ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3499
Mailing Address - Country:US
Mailing Address - Phone:228-831-2229
Mailing Address - Fax:228-831-9991
Practice Address - Street 1:15190 COMMUNITY ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3499
Practice Address - Country:US
Practice Address - Phone:228-831-2229
Practice Address - Fax:228-831-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03234Medicare ID - Type Unspecified