Provider Demographics
NPI:1417953233
Name:PRATT, JOSEPH L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:PRATT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:121 PRATT DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6026
Mailing Address - Country:US
Mailing Address - Phone:662-286-0088
Mailing Address - Fax:662-286-0067
Practice Address - Street 1:121 PRATT DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6026
Practice Address - Country:US
Practice Address - Phone:662-286-0088
Practice Address - Fax:662-286-0067
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2014-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS11767207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05206512Medicaid
MSP00139098OtherRAILROAD MEDICARE ID #
MS11767OtherSTATE MEDICAL LICENSE
MS080003879Medicare ID - Type Unspecified
MS05206512Medicaid
MS080003879Medicare ID - Type Unspecified