South Mississippi Maxillofacial Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOUTH MISSISSIPPI MAXILLOFACIAL SURGERY CENTER

Practice address

1760 Medical Park Dr
Suite B
Biloxi, MS 39532-2131

Phone

(228) 388-5925

Fax

(228) 388-8153

NPI assigned

May 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Robert T Watts, Jr, DMDNPI 1407809098

Title

Oral Physician/Medical Director

Phone

(228) 388-5925

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert T Watts, Jr, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Biloxi, MS
  • NPI 1407809098
  NPD (past) Authorized official
• Thomas Zakkak, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Biloxi, MS
  • NPI 1821041492
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902858004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1760 MEDICAL PARK DR",
            "address_2": "SUITE B",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395322131",
            "telephone_number": "228-388-5925",
            "fax_number": "228-388-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 MEDICAL PARK DR",
            "address_2": "SUITE B",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395322131",
            "telephone_number": "228-388-5925",
            "fax_number": "228-388-8153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MISSISSIPPI MAXILLOFACIAL SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WATTS, JR",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ORAL PHYSICIAN/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "228-388-5925",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1987800",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlos J Sosa Rodriguez, M.D.
• Brittany Corrin Souder, IDMT
• South Mississippi AIDS Task Force, Inc.
• South Mississippi Endodontics PA
• South Mississippi Home Health, Inc. (Deaconess Hospice)
• South Mississippi Nephrology, PLLC
• South Shore Radiology, LLC
• Trevor South
• Southern Home Care Services, Inc.
• Southerncare, Inc. (Gentiva)

• Ambulatory Surgical Clinic/Center in Biloxi, MS
• Providers in Biloxi, MS by specialty
• Ambulatory Surgical Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.