MEDICARE: GREENVILLE PRIMARY CARE II

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	08946	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	:	1659591428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE PRIMARY CARE II

Provider Business Mailing Address
First Line	:	2363 HIGHWAY 1 S
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-8337
Country	:	US
Telephone Number	:	662-334-1253
Fax Number	:	662-332-0443

Provider Business Practice Location Address
First Line	:	2363 HIGHWAY 1 S
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-8337
Country	:	US
Telephone Number	:	662-334-1253
Fax Number	:	662-332-0443

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ARVIS HAWKINS
Credential	:	MD
Telephone Number	:	662-334-1253

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	01/24/2008

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