Individual
JAMES WYATT STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
128 COURTHOUSE SQ, MONTICELLO, MS 39654-6014
(601) 587-0209
(601) 587-0436
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 587-0209
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20322
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05180817
—
MS
01
—
262986839
TRICARE
MS
01
—
9697227
AETNA
MS
Enumeration date
07/24/2007
Last updated
08/11/2020
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