Hardaway, Ollie

Hardaway, Ollie is an individual health care provider with primary practice located at 154 Cottonwood Street , Vicksburg MS 39180. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / Dentist is his primary health care specialty. Hardaway, Ollie can be contacted via phone (662) 873-4593.

Contact Information

Primary practice address
154 Cottonwood Street Vicksburg MS 39180
Phone: (662) 873-4593
Fax: (662) 873-4112
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 180178 Mississippi
Dental Providers / General Practice 1223G0001X 180178 Mississippi

Profile Details

NPI number 1063539138
LBN Legal business name Hardaway, Ollie
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2007
Last updated Dec 17th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063539138 NPPES
Mississippi MEDICAID 00660200

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