Individual provider · NPI-1

Lisa C Bushardt, MD

Family Medicine · Hattiesburg, MS

NPI number1669488979
StatusActive
Last updated in NPPESJul 8, 2020

Details

NPI
1669488979
Entity type
Individual (NPI-1)
Name
Lisa C Bushardt
Credential
MD
Sex
Female
Sole proprietor
No
Enumeration date
Jul 31, 2006
Certification date
Jul 8, 2020
Last updated
Jul 8, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine12307MSYes

Practice location

105 Thornhill Dr
Hattiesburg, MS 39402-1548

Phone 601-261-3737 · Fax 601-261-3899

Mailing address

415 S 28th Ave
Hattiesburg, MS 39401-7246

Phone 601-261-3737 · Fax 601-579-5240

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Family Medicine providers in Hattiesburg, MS