Healthcare Provider Details

I. General information

NPI: 1376549816
Provider Name (Legal Business Name): JOHN JOSEPH SHEEHAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET DEPARTMENT OF MEDICINE DIVISION OF DIGESTIVE DISEASE
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 NORTH STATE STREET DIVISION OF GASTROENTEROLOGY
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-4540
  • Fax: 601-984-4548
Mailing address:
  • Phone: 601-984-4540
  • Fax: 601-984-4548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number05144R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number17272
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: