Individual
THOMAS P FORKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7275 S SIWELL RD, JACKSON, MS 39272-9776
(601) 373-7722
(601) 373-7378
Mailing address
1151 N STATE ST, SUITE 408, JACKSON, MS 39202-2407
(601) 292-4261
(601) 292-4262
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12215
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119587
—
MS
01
—
168390702
DEPARTMENT OF LABOR
MS
01
—
4253992
AETNA
MS
01
—
753068151
MS HEALTH PARTNERS
MS
01
—
753068151008
TRICARE
MS
01
—
P00138501
RAILROAD MEDICARE
MS
Enumeration date
03/08/2006
Last updated
12/02/2010
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