Healthcare Provider Details

I. General information

NPI: 1295477123
Provider Name (Legal Business Name): SOMER NICOLE DURR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 LAKELAND DR STE 225
JACKSON MS
39216-4635
US

IV. Provider business mailing address

970 LAKELAND DR STE 225
JACKSON MS
39216-4635
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-6175
  • Fax:
Mailing address:
  • Phone: 601-200-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35713
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: