Healthcare Provider Details

I. General information

NPI: 1255334280
Provider Name (Legal Business Name): JAMES KENNETH HENSARLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4436 MANGUM DR. STE A
FLOWOOD MS
39232
US

IV. Provider business mailing address

4436 MANGUM DR. STE A
FLOWOOD MS
39232
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-7363
  • Fax: 601-981-8672
Mailing address:
  • Phone: 601-982-7363
  • Fax: 601-981-8672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number07313
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: