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NPI Code Detail

MEDICARE: DR. WILLIAM D LOGAN JR. MD

MEDICARE: DR. WILLIAM D LOGAN JR. 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
1207P00000XEmergency Medicine Physician03214MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
203214OTHERMSMS MEDICAL LICENSE

General Provider Information

NPI Number : 1891832747
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM D LOGAN JR. MD
Provider Business Mailing Address
First Line : 310 ELLIS ST
Second Line :
City : CARTHAGE
State : MS
Zip : 39051-3809
Country : US
Telephone Number : 601-267-1100
Fax Number : 601-267-1191
Provider Business Practice Location Address
First Line : 310 ELLIS ST
Second Line :
City : CARTHAGE
State : MS
Zip : 39051-3809
Country : US
Telephone Number : 601-267-1100
Fax Number : 601-267-1191
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 02/08/2026

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