MEDICARE: JOHN WAYNE PRATHER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	08877	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043233372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WAYNE PRATHER M.D.

Provider Business Mailing Address
First Line	:	611 ALCORN DR
Second Line	:	SUITE 230
City	:	CORINTH
State	:	MS
Zip	:	38834-9321
Country	:	US
Telephone Number	:	662-287-5218
Fax Number	:	662-286-3186

Provider Business Practice Location Address
First Line	:	611 ALCORN DR
Second Line	:	SUITE 230
City	:	CORINTH
State	:	MS
Zip	:	38834-9321
Country	:	US
Telephone Number	:	662-287-5218
Fax Number	:	662-286-3186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/11/2012

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Directions to “ JOHN WAYNE PRATHER M.D.” Practice Location

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