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NPI Code Detail

MEDICARE: CHILDREN'S MEDICAL GROUP, P.A.

MEDICARE: CHILDREN'S MEDICAL GROUP, P.A.
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
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1588700603
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S MEDICAL GROUP, P.A.
Provider Business Mailing Address
First Line : 1867 CRANE RIDGE DR STE 101B
Second Line :
City : JACKSON
State : MS
Zip : 39216-4956
Country : US
Telephone Number : 601-362-8776
Fax Number : 601-354-8786
Provider Business Practice Location Address
First Line : 1867 CRANE RIDGE DR STE 101B
Second Line :
City : JACKSON
State : MS
Zip : 39216-4956
Country : US
Telephone Number : 601-362-8776
Fax Number : 601-354-8786
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIAM H. SMITH JR.
Credential : M.D.
Telephone Number : 601-856-5105
Provider Enumeration Date : 01/29/2007
Last Update Date : 08/22/2020

Similar Medicare Providers

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Practice Location Address:
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1265543623 — DR. SAMUEL P, HOPPER M.D.
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1205947652 — DR. PAUL B. WELCH M.D.
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39216-4956
Practice Phone: 601-362-8776
Practice Fax: 601-354-8786
1356452791 — DR. ERWYN E. FREEMAN JR. M.D.
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1669583027 — DR. MELINDA S. RAY M.D.
Practice Location Address:
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1457576878 — KRISTIE S. ROHMAN M.D.
Practice Location Address:
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39216-4956
Practice Phone: 601-362-8776
Practice Fax: 601-354-8786

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