Healthcare Provider Details

I. General information

NPI: 1609292705
Provider Name (Legal Business Name): JOHN D. ISAACS JR., M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL ST STE 600
JACKSON MS
39202-1650
US

IV. Provider business mailing address

501 MARSHALL ST STE 600
JACKSON MS
39202-1650
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-6540
  • Fax: 601-326-1501
Mailing address:
  • Phone: 601-948-6540
  • Fax: 601-326-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE FERGUSON
Title or Position: ADMINSTRATOR
Credential: RN, BSN, CPCO
Phone: 601-948-6540