Provider Demographics
NPI:1336118843
Name:FARMER, GUY R JR (DO)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:R
Last Name:FARMER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:870-934-5821
Mailing Address - Fax:870-934-5384
Practice Address - Street 1:232 STARLYN AVE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-2428
Practice Address - Country:US
Practice Address - Phone:662-534-5891
Practice Address - Fax:662-534-5970
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14294207P00000X, 208600000X
IN02002767A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200482400Medicaid
MS05924350Medicaid
IN11484466OtherCAQH NUMBER
IN9397057OtherPHCS PID NUMBER
IN000000333616OtherANTHEM PROVIDER NUMBER
ING35939Medicare UPIN
INP00195560Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
IN921480EEMedicare PIN
IN224390VMedicare PIN
IN815500ZZZZMedicare PIN
MS512I020043Medicare PIN
IN815490EEEMedicare PIN