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General NPI Number Information
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NPI Number | 1043673833
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Entity Type | Individual
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Provider Name | JAMES MARK SHOCKLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 2124 14TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4040
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Country | US
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Telephone | 601-553-6000
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Fax | 601-553-6144
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Provider Business Mailing Address
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Address Line | 2000 BANQUOS TRL
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City | PENSACOLA
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State | FL
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Zip | 32503-5837
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Country | US
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Telephone | 205-657-4741
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25482
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 38180
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME140457
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License Number State | FL
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