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NPI Code Detail

MEDICARE: JCEP,PLLC,

MEDICARE: JCEP,PLLC,
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
1207Q00000XFamily Medicine Physician08027MS

General Provider Information

NPI Number : 1780887133
Entity Type Code : Organization
Provider Name (Legal Business Name) : JCEP,PLLC,
Provider Business Mailing Address
First Line : PO BOX 1992
Second Line :
City : MADISON
State : MS
Zip : 39130-1992
Country : US
Telephone Number : 601-923-6200
Fax Number : 601-923-9111
Provider Business Practice Location Address
First Line : 2147 HENRY HILL DR
Second Line : SUITE 109
City : JACKSON
State : MS
Zip : 39204-2001
Country : US
Telephone Number : 601-923-6200
Fax Number : 601-923-9111
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. OLUFEMI OLUSOLA OKUNOREN
Credential : M.D.
Telephone Number : 601-923-6200
Provider Enumeration Date : 06/05/2007
Last Update Date : 10/22/2007

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