Individual
GREGORY TIMBERLAKE
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) 984-1000
(601) 815-4570
Mailing address
PO BOX 3287, JACKSON, MS 39207-3287
(601) 984-1000
(601) 815-4570
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
17108
MS
2086S0102X
Surgical Critical Care Physician
Primary
17108
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123637
—
MS
01
—
P01233200
RAILROAD MEDICARE
MS
Enumeration date
10/18/2006
Last updated
12/16/2013
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