Individual
JOHN COLVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5582
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5582
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
T-3035
MS
390200000X
Student in an Organized Health Care Education/Training Program
390200000
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01800228
—
MS
Enumeration date
05/15/2015
Last updated
09/14/2015
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