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
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