Provider Demographics
NPI:1508022237
Name:JAMES W STEPHENS MD FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:JAMES W STEPHENS MD FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-587-0209
Mailing Address - Street 1:128 COURTHOUSE SQ
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-6014
Mailing Address - Country:US
Mailing Address - Phone:601-587-0209
Mailing Address - Fax:601-587-0436
Practice Address - Street 1:128 COURTHOUSE SQ
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-6014
Practice Address - Country:US
Practice Address - Phone:601-587-0209
Practice Address - Fax:601-587-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20322261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512G700335OtherPTAN
MS1326248774OtherDR'S INDIVIDUAL NPI