Healthcare Provider Details

I. General information

NPI: 1609531276
Provider Name (Legal Business Name): DEARMAN MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CIRCLE J DR STE 1
LAUREL MS
39440-1981
US

IV. Provider business mailing address

30 CIRCLE J DR STE 3
LAUREL MS
39440-1981
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-0092
  • Fax:
Mailing address:
  • Phone: 601-425-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAYE D JONES
Title or Position: MEMBER
Credential:
Phone: 601-425-0092