Provider Demographics
NPI:1659388585
Name:HEY, JOHN PHENIS III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHENIS
Last Name:HEY
Suffix:III
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 1:405 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-4212
Mailing Address - Country:US
Mailing Address - Phone:662-453-6177
Mailing Address - Fax:662-453-7787
Practice Address - Street 1:405 RIVER RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4212
Practice Address - Country:US
Practice Address - Phone:662-453-6177
Practice Address - Fax:662-453-7787
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4986207Q00000X, 207QS1201X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00012178Medicaid
MS012619029Medicare PIN
MSB-30141Medicare UPIN
MS012619029Medicare ID - Type UnspecifiedMEDICARE NUMBER