Healthcare Provider Details

I. General information

NPI: 1992998124
Provider Name (Legal Business Name): FARMER AND ASSOCIATES INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 CHADWICK DR SUITE 303
JACKSON MS
39204-3463
US

IV. Provider business mailing address

1860 CHADWICK DR SUITE 303
JACKSON MS
39204-3463
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-2791
  • Fax: 601-376-2792
Mailing address:
  • Phone: 601-376-2791
  • Fax: 601-376-2792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number16951
License Number StateMS

VIII. Authorized Official

Name: JOHN C FARMER
Title or Position: CEO
Credential: M.D,
Phone: 601-376-2791