Basic Information
| Provider Information | |||||||||
| NPI: | 1407290703 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | G.V. SONNY MONTGOMERY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 E WOODROW WILSON AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392165116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013624471 | ||||||||
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| Practice Location | |||||||||
| Address1: | 425 BEASLEY RD APT K5 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392062929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013624471 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2013 | ||||||||
| LastUpdateDate: | 04/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | TAMATHA | ||||||||
| AuthorizedOfficialMiddleName: | TENILLE | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED RESPIRATORY THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 6013624471 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RRT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | RCP4433 | MS | Y | Hospitals | Military Hospital |
No ID Information.