Provider Demographics
NPI:1073617775
Name:SNEED, JIMMY DARRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:DARRELL
Last Name:SNEED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 JEFFERSON DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5221
Mailing Address - Country:US
Mailing Address - Phone:662-281-1115
Mailing Address - Fax:662-281-1113
Practice Address - Street 1:391 SOUTHCREST CIR STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6729
Practice Address - Country:US
Practice Address - Phone:901-271-1000
Practice Address - Fax:901-271-4187
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21616207RI0011X
TNMD0000043843207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02901023Medicaid
TN21616OtherMS LICENSE NUMBER