Bushardt, Lisa C

Bushardt, Lisa C is an individual health care provider with primary practice located at 105 Thornhill Dr , Hattiesburg MS 39402-1548. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Bushardt, Lisa C can be contacted via phone (601) 261-3737.

Contact Information

Primary practice address
105 Thornhill Dr Hattiesburg MS 39402-1548
Phone: (601) 261-3737
Fax: (601) 261-3899
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 12307 Mississippi

Profile Details

NPI number 1669488979
LBN Legal business name Bushardt, Lisa C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 31st, 2006
Last updated Jul 8th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669488979 NPPES
Mississippi MEDICAID 00012749
Mississippi Other 110028735
Mississippi Other 1558923
Mississippi MEDICAID 1419877

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