Individual
DR. JACOB C. PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO, MD
Contact information
Practice address
300 FAIRWAY DR, HATTIESBURG, MS 39401-7715
(601) 307-5339
Mailing address
300 FAIRWAY DR, HATTIESBURG, MS 39401-7715
(601) 329-1321
Taxonomy
Speciality
Code
Description
License number
State
103TP0814X
Psychoanalysis Psychologist
8420042213
IL
163WC0400X
Case Management Registered Nurse
MS80885
MS
246Z00000X
Other Specialist/Technologist
800341120
HI
246Z00000X
Other Specialist/Technologist
Primary
800341120
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
251123217211
CLIA LICENSES
MS
01
—
25187411
CLINICAL LABORATORY IMPROVEMENT AMENDMENTS
MS
05
—
314125401870
—
MS
05
—
7NQ3-KD9-CK19
—
MS
05
—
800341120
—
MS
01
—
MS80885
MEDICAL LICENSES
MS
Enumeration date
12/24/2018
Last updated
11/11/2025
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