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General NPI Number Information
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NPI Number | 1780887133
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Entity Type | Organization
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Legal Business Name | JCEP,PLLC,
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 2147 HENRY HILL DR SUITE 109
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City | JACKSON
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State | MS
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Zip | 39204-2001
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Country | US
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Telephone | 601-923-6200
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Fax | 601-923-9111
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Provider Business Mailing Address
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Address Line | PO BOX 1992
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City | MADISON
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State | MS
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Zip | 39130-1992
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Country | US
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Telephone | 601-923-6200
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Fax | 601-923-9111
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. OLUFEMI OLUSOLA OKUNOREN
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Credential | M.D.
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Telephone | 601-923-6200
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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 | 08027
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License Number State | MS
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