Diberville Medical Spa

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

DIBERVILLE MEDICAL SPA

Practice address

3661 Sangani Blvd
Suite C
Diberville, MS 39540-8706

Phone

(228) 223-1927

NPI assigned

Mar 2, 2012

Last updated

Mar 2, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ronnie Ali, DO

Title

President

Phone

(228) 223-1927

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1330646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330646400000",
    "number": "1861766289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1248",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395661248",
            "telephone_number": "228-223-1927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3661 SANGANI BLVD",
            "address_2": "SUITE C",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395408706",
            "telephone_number": "228-223-1927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIBERVILLE MEDICAL SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-02",
        "last_updated": "2012-03-02",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "RONNIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "228-223-1927",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Crocker, RBT
• Lindsey Rachelle Cuevas, PHARMD
• D'Iberville Chiropractic Clinic, Inc.
• D'Iberville Medical Clinic LLC
• Andrea L Davis, D.D.S.
• Carla Diane Diffenderfer, FNP
• Shekina T Dillon, NURSE PRACTITIONER
• Sarah Sage Dolbear, M.D
• Maria Morrison Dominick, PMHNP
• Ellen Donaldson

• Clinic/Center in D'Iberville, MS
• Providers in D'Iberville, MS by specialty
• Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; 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.