MEDICARE: JOHN M ABIDE MD

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	174400000X	Specialist	06972	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	:	1992704530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN M ABIDE MD

Provider Business Mailing Address
First Line	:	481 CYPRESS LN
Second Line	:	APT. A103
City	:	GREENVILLE
State	:	MS
Zip	:	38701-7473
Country	:	US
Telephone Number	:	662-332-3391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 S MAIN ST
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-6342
Country	:	US
Telephone Number	:	662-335-3847
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/09/2007

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Directions to “ JOHN M ABIDE MD” Practice Location

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