Provider Demographics
NPI:1376744151
Name:SCREWS, JEREMY CLARK (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:CLARK
Last Name:SCREWS
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 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-3500
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:4210 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3093
Practice Address - Country:US
Practice Address - Phone:601-261-3500
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN379922080P0206X
MS292942080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02181532Medicaid