Healthcare Provider Details

I. General information

NPI: 1821182080
Provider Name (Legal Business Name): JEPTHA NEWTON COLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N FLOWOOD DR
JACKSON MS
39232-9532
US

IV. Provider business mailing address

204 E LAYFAIR DR
FLOWOOD MS
39232-9526
US

V. Phone/Fax

Practice location:
  • Phone: 601-933-2004
  • Fax: 601-896-0112
Mailing address:
  • Phone: 601-933-2004
  • Fax: 601-896-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number15530
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: