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General NPI Number Information
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NPI Number | 1073798781
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Entity Type | Individual
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Provider Name | JEFF JORDAN CUNNINGHAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 7165 GETWELL RD BLDG H, SUITE 1
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City | SOUTHAVEN
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State | MS
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Zip | 38672-9618
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Country | US
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Telephone | 662-349-7676
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Fax | 662-349-7679
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Provider Business Mailing Address
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Address Line | 7165 GETWELL RD BLDG H, SUITE 1
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City | SOUTHAVEN
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State | MS
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Zip | 38672-9618
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Country | US
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Telephone | 662-349-7676
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Fax | 662-349-7679
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 20122
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 43312
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License Number State | TN
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