Individual
JACKIE E. MCHENRY II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
140 BURKE CALHOUN CITY RD, CALHOUN CITY, MS 38916
(662) 628-6300
Mailing address
1111 N CAUSEWAY BLVD, MANDEVILLE, LA 70471-3409
(985) 773-1844
(985) 893-8272
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14485
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00113820
—
MS
01
—
080185585
RAILROAD MEDICARE
—
Enumeration date
11/20/2005
Last updated
06/05/2018
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