MEDICARE: DR. JAMES D POLK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	06229	MS

General Provider Information

NPI Number	:	1083601348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES D POLK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 180367
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-0367
Country	:	US
Telephone Number	:	601-932-6400
Fax Number	:	601-932-6437

Provider Business Practice Location Address
First Line	:	1201 HIGHWAY 49 S STE 4
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-9425
Country	:	US
Telephone Number	:	601-932-6400
Fax Number	:	601-932-6437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	04/19/2011

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Directions to “ DR. JAMES D POLK M.D.” Practice Location

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