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General NPI Number Information
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NPI Number | 1255334280
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Entity Type | Individual
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Provider Name | JAMES KENNETH HENSARLING MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 4436 MANGUM DR. STE A
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City | FLOWOOD
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State | MS
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Zip | 39232
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Country | US
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Telephone | 601-982-7363
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Fax | 601-981-8672
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Provider Business Mailing Address
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Address Line | 4436 MANGUM DR. STE A
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City | FLOWOOD
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State | MS
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Zip | 39232
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Country | US
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Telephone | 601-982-7363
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Fax | 601-981-8672
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 07313
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License Number State | MS
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