Healthcare Provider Details

I. General information

NPI: 1467433441
Provider Name (Legal Business Name): JEFFERSON HOPKINS HARMAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 OLD SPANISH TRL
GAUTIER MS
39553-6000
US

IV. Provider business mailing address

2105 OLD SPANISH TRL
GAUTIER MS
39553-6000
US

V. Phone/Fax

Practice location:
  • Phone: 228-205-7700
  • Fax: 228-205-7715
Mailing address:
  • Phone: 228-205-7700
  • Fax: 228-205-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 78679
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24199
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: