=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699160143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH W GUNTER III MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2015
-----------------------------------------------------
Last Update Date | 04/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 156 RIVER OAKS DR SUITE B
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39046-5376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-605-6020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 BELLE POINTE CIR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39110-7480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-613-1373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. JOSEPH W GUNTER III
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 601-613-1373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 20808
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------