Charles Randle Dishongh, M.D.
Individual provider Active NPI Specialist · Greenville, MS
NPI 1407948946 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1407948946
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 07645 (MS)
- Practice address
- 1467 Highway 1 South
Greenville, MS 38701 - Phone
- (662) 335-1621
- Fax
- (662) 335-8128
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07645 | MS | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 07645 | MS | Yes |
Addresses
Primary practice location
1467 Highway 1 South
Greenville, MS 38701
Mailing address
P. O. Box 4618
Greenville, MS 38701-4618
Phone (662) 335-1621
Other providers in Greenville, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.