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General NPI Number Information
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NPI Number | 1083643761
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Entity Type | Organization
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Legal Business Name | J.C. PASSMAN MDPA
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 46 SGT PRENTISS DR SUITE 103
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City | NATCHEZ
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State | MS
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Zip | 39120-4792
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Country | US
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Telephone | 601-442-9654
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Fax | 601-442-9790
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Provider Business Mailing Address
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Address Line | 46 SGT PRENTISS DR SUITE 103
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City | NATCHEZ
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State | MS
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Zip | 39120-4792
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Country | US
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Telephone | 601-442-9654
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Fax | 601-442-9790
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT BRIAN HAIMSON
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Credential | MD
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Telephone | 601-442-9654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0333
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 05227
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License Number State | MS
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