MEDICARE: MARION JEWETT SORRELS D.O.

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	18610	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	:	1710922638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARION JEWETT SORRELS D.O.

Provider Business Mailing Address
First Line	:	PO BOX 2065
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39302-2065
Country	:	US
Telephone Number	:	601-703-3018
Fax Number	:	601-703-9283

Provider Business Practice Location Address
First Line	:	1080 HIGHWAY 35 S
Second Line	:
City	:	FOREST
State	:	MS
Zip	:	39074-9423
Country	:	US
Telephone Number	:	601-469-3555
Fax Number	:	601-469-3584

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	09/22/2015

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