Healthcare Provider Details

I. General information

NPI: 1326510751
Provider Name (Legal Business Name): JACOB C. PARKER DO, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHRISTEN DANIELS DO

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date: 09/22/2020
Reactivation Date: 07/20/2021

III. Provider practice location address

300 FAIRWAY DR
HATTIESBURG MS
39401-7715
US

IV. Provider business mailing address

300 FAIRWAY DR
HATTIESBURG MS
39401-7715
US

V. Phone/Fax

Practice location:
  • Phone: 601-307-5339
  • Fax:
Mailing address:
  • Phone: 601-329-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number800341120
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number8420042213
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberMS80885
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number800341120
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: