Individual
JOSEPH MATTHEW FAIRLEY SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1466 KRISTEN DR, JACKSON, MS 39211-2115
(601) 497-4757
Mailing address
1466 KRISTEN DR, JACKSON, MS 39211-2115
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
800718433
—
MS
05
—
80078433
—
MS
Enumeration date
12/24/2020
Last updated
12/24/2020
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