Individual
JOHN T CHMELICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 SHELBY SPEIGHTS DR, PURVIS, MS 39475-4151
(601) 794-8065
(601) 794-5650
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 794-8065
(601) 794-5650
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13049
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00110831
—
MS
01
—
1558928
AMERICAN ADMIN GROUP
MS
05
—
1677841
—
LA
Enumeration date
08/01/2006
Last updated
04/08/2008
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