Organization
PMGROUP
Active
Organization
PMGROUP
Active
Other names
Lab Testing Facility, Lab Testing Facility
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB CORNELIUS PARKER DO,MD (PSYCHIATRIST)
(601) 329-1321
Entity
Organization
Contact information
Practice address
300 FAIRWAY DR, HATTIESBURG, MS 39401-7715
(601) 329-1321
Mailing address
300 FAIRWAY DR, HATTIESBURG, MS 39401-7715
(601) 329-1321
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800347
HEALTHCARE EMPLOYER PROVIDER
MS
Enumeration date
02/19/2021
Last updated
05/06/2024
Update your record
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