Provider Demographics
NPI:1144302738
Name:JACQUELINE L HAMPTON MD PLLC
Entity type:Organization
Organization Name:JACQUELINE L HAMPTON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-327-3494
Mailing Address - Street 1:255 BAPTIST BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2011
Mailing Address - Country:US
Mailing Address - Phone:662-327-3494
Mailing Address - Fax:662-327-2169
Practice Address - Street 1:255 BAPTIST BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2011
Practice Address - Country:US
Practice Address - Phone:662-327-3494
Practice Address - Fax:662-327-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04737501Medicaid