Healthcare Provider Details

I. General information

NPI: 1356519227
Provider Name (Legal Business Name): JAMES E ROBERTS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 N JACKSON ST SUITE D
BROOKHAVEN MS
39601-2952
US

IV. Provider business mailing address

PO BOX 379
BROOKHAVEN MS
39602-0379
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-2222
  • Fax: 601-823-3073
Mailing address:
  • Phone: 601-833-2222
  • Fax: 601-823-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13205
License Number StateMS

VIII. Authorized Official

Name: DR. JAMES E ROBERTS
Title or Position: PRESIDENT
Credential: MD
Phone: 601-833-2222