MEDICARE: PHILLIP JEFF BARKLEY DMD

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	122300000X	Dentist	MS303398	MS

General Provider Information

NPI Number	:	1679635320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP JEFF BARKLEY DMD

Provider Business Mailing Address
First Line	:	5643 HWY 18 SOUTH
Second Line	:	SUITE G
City	:	JACKSON
State	:	MS
Zip	:	39209
Country	:	US
Telephone Number	:	601-922-0056
Fax Number	:	601-922-0056

Provider Business Practice Location Address
First Line	:	5643 HWY 18 SOUTH
Second Line	:	SUITE G
City	:	JACKSON
State	:	MS
Zip	:	39209
Country	:	US
Telephone Number	:	601-922-0056
Fax Number	:	601-922-0056

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	05/12/2014

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