MEDICARE: JENNIFER D GHOLSON MD, LLC

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

General Provider Information

NPI Number	:	1487967410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER D GHOLSON MD, LLC

Provider Business Mailing Address
First Line	:	804 ROBB ST
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-8291
Country	:	US
Telephone Number	:	601-276-7665
Fax Number	:	601-276-7655

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	:	601-276-7655

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JENNIFER GHOLSON
Credential	:	MD
Telephone Number	:	601-276-7665

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	06/16/2015

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