Healthcare Provider Details

I. General information

NPI: 1013320993
Provider Name (Legal Business Name): DR. MARCIA L HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST DEPT OF FAMILY MEDICINE
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST DEPT OF FAMILY MEDICINE
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5426
  • Fax: 601-984-6889
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number912-L
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: