Healthcare Provider Details

I. General information

NPI: 1851433585
Provider Name (Legal Business Name): JAMES MICHAEL PACE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 SOUTH FRONT STREET
RICHTON MS
39476
US

IV. Provider business mailing address

PO BOX 850
RICHTON MS
39476-0850
US

V. Phone/Fax

Practice location:
  • Phone: 601-788-6381
  • Fax: 601-788-9716
Mailing address:
  • Phone: 601-788-5582
  • Fax: 601-788-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15454
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: