Ollie Hardaway Jr., D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

180178 Issued in MS

Practice address

154 Cottonwood Street
Vicksburg, MS 39180

Phone

(662) 873-4593

Fax

(662) 873-4112

NPI assigned

Mar 23, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197849600000",
    "number": "1063539138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 RIALTO ST",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391806030",
            "telephone_number": "601-636-0834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 COTTONWOOD STREET",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "39180",
            "telephone_number": "662-873-4593",
            "fax_number": "662-873-4112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDAWAY",
        "first_name": "OLLIE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2007-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "180178",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "180178",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00660200",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.