Provider Demographics
NPI:1891896510
Name:HOWARD, AUSTIN ARCHIE JR (MD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ARCHIE
Last Name:HOWARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A
Other - Middle Name:ARCHIE
Other - Last Name:HOWARD
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 MEDICAL LN
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-4039
Mailing Address - Country:US
Mailing Address - Phone:601-469-4861
Mailing Address - Fax:601-469-1238
Practice Address - Street 1:1 MEDICAL LN
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-4039
Practice Address - Country:US
Practice Address - Phone:601-469-4861
Practice Address - Fax:601-469-1238
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0116046Medicaid
MS080000016Medicare ID - Type UnspecifiedMEDICARE
MS0116046Medicaid