Healthcare Provider Details

I. General information

NPI: 1083601348
Provider Name (Legal Business Name): JAMES D POLK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HIGHWAY 49 S STE 4
RICHLAND MS
39218-9425
US

IV. Provider business mailing address

PO BOX 180367
RICHLAND MS
39218-0367
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-6400
  • Fax: 601-932-6437
Mailing address:
  • Phone: 601-932-6400
  • Fax: 601-932-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06229
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: