MEDICARE: DR. ANCEL C TIPTON 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	2084N0400X	Neurology Physician	05163	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548366768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANCEL C TIPTON M.D.

Provider Business Mailing Address
First Line	:	971 LAKELAND DR
Second Line	:	SUITE 557
City	:	JACKSON
State	:	MS
Zip	:	39216-4643
Country	:	US
Telephone Number	:	601-362-1577
Fax Number	:	601-368-9394

Provider Business Practice Location Address
First Line	:	971 LAKELAND DR
Second Line	:	STE 1060
City	:	JACKSON
State	:	MS
Zip	:	39216-4609
Country	:	US
Telephone Number	:	601-362-1577
Fax Number	:	601-368-9394

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	02/01/2017

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Directions to “ DR. ANCEL C TIPTON M.D.” Practice Location

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