Healthcare Provider Details

I. General information

NPI: 1033150263
Provider Name (Legal Business Name): BOB HUTCHINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 ELLIS AVE
JACKSON MS
39209-6256
US

IV. Provider business mailing address

PO BOX 746085
ATLANTA GA
30374-6085
US

V. Phone/Fax

Practice location:
  • Phone: 601-533-7016
  • Fax:
Mailing address:
  • Phone: 469-727-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number09818
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number09818
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: