Provider Demographics
NPI:1568445518
Name:FOUTS, ANTHONY C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:C
Last Name:FOUTS
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 1:1800 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4158
Mailing Address - Country:US
Mailing Address - Phone:601-703-9224
Mailing Address - Fax:601-703-1352
Practice Address - Street 1:1800 12TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4158
Practice Address - Country:US
Practice Address - Phone:601-703-9224
Practice Address - Fax:601-703-1352
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115730Medicaid
AL731-04347OtherBLUE CROSS OF ALABAMA
MS110050138OtherRAILROAD MEDICARE
AL008204810Medicaid
AL008204810Medicaid
MS00115730Medicaid