MEDICARE: GARDEN PARK PHYSICIAN GROUP INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	367A00000X	Advanced Practice Midwife
3	207R00000X	Internal Medicine Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285660688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN PARK PHYSICIAN GROUP INC

Provider Business Mailing Address
First Line	:	3 MARYLAND FARMS
Second Line	:	SUITE 250
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5005
Country	:	US
Telephone Number	:	615-373-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 E PASS RD
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-3236
Country	:	US
Telephone Number	:	228-896-6505
Fax Number	:	228-896-6509

Authorized Official
Title or Position	:	VP
Name	:	MR. LOUIS R. JOSEPH
Credential	:
Telephone Number	:	615-373-7600

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	03/15/2013

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