MEDICARE: DAVID MCCAA HEADLEY MD

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	207Q00000X	Family Medicine Physician	09133	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1528032406	OTHER	MS	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1528032406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MCCAA HEADLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 676
Second Line	:
City	:	PORT GIBSON
State	:	MS
Zip	:	39150
Country	:	US
Telephone Number	:	601-437-3323
Fax Number	:	601-437-8499

Provider Business Practice Location Address
First Line	:	405 MARKET ST
Second Line	:
City	:	PORT GIBSON
State	:	MS
Zip	:	39150
Country	:	US
Telephone Number	:	601-437-3323
Fax Number	:	601-437-8499

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	04/03/2012

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Directions to “ DAVID MCCAA HEADLEY MD” Practice Location

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