Mmo of Hattiesburg, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MMO OF HATTIESBURG, LLC

Practice address

990 Hardy St
Suite 4
Hattiesburg, MS 39401-4161

Phone

(601) 602-0194

Fax

(601) 602-0197

NPI assigned

May 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Robert L. Miller

Title

Ceo

Phone

(225) 293-6774

Specialties & licenses 1

Addresses

Other names 1

• Delta Medical Systems, LLC Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Archil Chechelashvili, MD

  • Psychiatry Physician
  • Plattsburgh, NY
  • NPI 1609989102
  NPD (past)

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278028800000",
    "number": "1629022017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "728 NORTH BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708025724",
            "telephone_number": "225-293-6774",
            "fax_number": "225-291-9229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 HARDY ST",
            "address_2": "SUITE 4",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394014161",
            "telephone_number": "601-602-0194",
            "fax_number": "601-602-0197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMO OF HATTIESBURG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2010-07-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-293-6774",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Medical Systems, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jesse Mitchell, LCSW
• Madison Grace Mitchell
• Shanice Mitchell
• Lydia Jonae Mitzel
• Tiffany Mixon
• Kelli Jo Mobbs, RBT
• Mobile One Non-Emergency Transport Service, LLC
• Mobility Systems, Inc
• Katelyn Moen
• Martia Moffett, LCSW

• Mental Health Clinic/Center (Including Community Mental Health Center) in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; 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.