Individual
THOR MATTHEW GOODFELLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5601
(601) 984-6665
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5601
(601) 984-6665
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
30132
MS
207R00000X
Internal Medicine Physician
T-3775
MS
Other
Enumeration date
04/03/2019
Last updated
04/29/2025
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