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General NPI Number Information
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NPI Number | 1285639302
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Entity Type | Individual
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Provider Name | JESSIE MICHAEL COCKRELL MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 120 NORFLEET DR
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City | SENATOBIA
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State | MS
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Zip | 38668-2231
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Country | US
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Telephone | 662-301-1128
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Fax | 662-301-4430
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Provider Business Mailing Address
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Address Line | 120 NORFLEET DR
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City | SENATOBIA
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State | MS
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Zip | 38668-2220
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Country | US
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Telephone | 662-301-1128
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Fax | 662-301-4430
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17248
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License Number State | MS
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