Healthcare Provider Details

I. General information

NPI: 1396784302
Provider Name (Legal Business Name): JIM WADE PRICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7306 HIGHWAY 11
CARRIERE MS
39426-7864
US

IV. Provider business mailing address

7306 HIGHWAY 11
CARRIERE MS
39426-7864
US

V. Phone/Fax

Practice location:
  • Phone: 601-840-8004
  • Fax: 601-510-5268
Mailing address:
  • Phone: 601-840-8004
  • Fax: 601-510-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number11571
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number07540R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: