Provider Demographics
NPI:1578980298
Name:HENRY FLAUTT JR MD PA
Entity Type:Organization
Organization Name:HENRY FLAUTT JR MD PA
Other - Org Name:HENRY FLAUTT JR MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:FLAUTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-453-0722
Mailing Address - Street 1:408 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-4232
Mailing Address - Country:US
Mailing Address - Phone:662-453-0722
Mailing Address - Fax:662-453-5284
Practice Address - Street 1:408 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4232
Practice Address - Country:US
Practice Address - Phone:662-453-0722
Practice Address - Fax:662-453-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13172207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0113766Medicaid
MS0113766Medicaid