Healthcare Provider Details

I. General information

NPI: 1790703890
Provider Name (Legal Business Name): JAMES R. CAVETT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

PO BOX 2121
MEMPHIS TN
38159-0001
US

V. Phone/Fax

Practice location:
  • Phone: 601-968-3070
  • Fax: 601-974-6286
Mailing address:
  • Phone: 601-968-3070
  • Fax: 601-974-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number11470
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: