MEDICARE: DR. JENNIFER GHOLSON MD

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	17561	MS

General Provider Information

NPI Number	:	1174588834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER GHOLSON MD

Provider Business Mailing Address
First Line	:	PO BOX 1268
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-1268
Country	:	US
Telephone Number	:	601-276-7665
Fax Number	:

Provider Business Practice Location Address
First Line	:	804 ROBB ST
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-8291
Country	:	US
Telephone Number	:	601-276-7665
Fax Number	:

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	06/16/2015

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