Provider Demographics
NPI:1821025263
Name:HEWITT, CARLA C (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:C
Last Name:HEWITT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:UNIVERSITY PHYSICIANS, PLLC
Mailing Address - Street 2:P.O. BOX 24146
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4146
Mailing Address - Country:US
Mailing Address - Phone:601-815-5047
Mailing Address - Fax:601-815-9596
Practice Address - Street 1:DEPARTMENT OF MEDICINE/DIVISION OF CARDIOLOGY
Practice Address - Street 2:2500 NORTH STATE STREET
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS14427207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121928Medicaid
MSH13226Medicare UPIN