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NPI Code Detail

MEDICARE: COREY WAYNE SIVILS M.D.

MEDICARE: COREY WAYNE SIVILS M.D.
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
12085R0202XDiagnostic Radiology Physician28818MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841679636
Entity Type Code : Individual
Provider Name (Legal Business Name) : COREY WAYNE SIVILS M.D.
Provider Business Mailing Address
First Line : 2500 N STATE ST
Second Line : DEPARTMENT OF MEDICINE
City : JACKSON
State : MS
Zip : 39216-4500
Country : US
Telephone Number : 601-984-5601
Fax Number : 601-984-6601
Provider Business Practice Location Address
First Line : 2500 N STATE ST
Second Line : DEPARTMENT OF MEDICINE
City : JACKSON
State : MS
Zip : 39216-4500
Country : US
Telephone Number : 601-984-5601
Fax Number : 601-984-6601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2015
Last Update Date : 05/06/2026

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Directions to “ COREY WAYNE SIVILS M.D.” Practice Location

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