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Contact Information

OLLIE HARDAWAY JR, DDS
154 COTTONWOOD STREET
VICKSBURG, MS39180
 Phone: 662-873-4593
 Fax: 662-873-4112
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
 

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for OLLIE HARDAWAY JR · (Male)

NPI Number 1063539138
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 03/23/2007
Last updated 12/17/2007 - About 18 years ago
Sole proprietor 1 No
Identifiers
  • MS License # 180178
  • MS Medicaid 00660200
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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