Healthcare Provider Details

I. General information

NPI: 1477698926
Provider Name (Legal Business Name): JAMES PUCKETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 HIGHWAY 49 SUITE 119
HATTIESBURG MS
39401
US

IV. Provider business mailing address

PO BOX 16863
HATTIESBURG MS
39404-6863
US

V. Phone/Fax

Practice location:
  • Phone: 601-296-6001
  • Fax: 601-268-1222
Mailing address:
  • Phone: 601-268-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number06457
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: