Provider Demographics
NPI:1821321993
Name:JAMES W. FITE, MD
Entity Type:Organization
Organization Name:JAMES W. FITE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:FITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-226-0325
Mailing Address - Street 1:340 VAN DORN ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4738
Mailing Address - Country:US
Mailing Address - Phone:662-226-0325
Mailing Address - Fax:662-226-0327
Practice Address - Street 1:340 VAN DORN ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4738
Practice Address - Country:US
Practice Address - Phone:662-226-0325
Practice Address - Fax:662-226-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07186208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07721732Medicaid