Healthcare Provider Details

I. General information

NPI: 1598847428
Provider Name (Legal Business Name): JOHN H NADING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 SOUTH EASON BLVD
TUPELO MS
38801
US

IV. Provider business mailing address

PO BOX 3970
TUPELO MS
38803-3970
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-4905
  • Fax: 662-377-4906
Mailing address:
  • Phone: 662-377-4905
  • Fax: 662-377-4906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14034
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number14034
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: