MEDICARE: DR. JOHN CARROLL SANDEFUR 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
1	208600000X	Surgery Physician	03945	MS

General Provider Information

NPI Number	:	1902153620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CARROLL SANDEFUR M.D.

Provider Business Mailing Address
First Line	:	313 ARNOLD AVE
Second Line	:	SUITE A
City	:	GREENVILLE
State	:	MS
Zip	:	38701-4712
Country	:	US
Telephone Number	:	662-332-5151
Fax Number	:	662-332-5152

Provider Business Practice Location Address
First Line	:	313 ARNOLD AVE
Second Line	:	SUITE A
City	:	GREENVILLE
State	:	MS
Zip	:	38701-4712
Country	:	US
Telephone Number	:	662-332-5151
Fax Number	:	662-332-5152

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

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	02/22/2026

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