Provider Demographics
NPI:1134250855
Name:DRUMMOND, JAMES JOEL (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOEL
Last Name:DRUMMOND
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3104
Mailing Address - Country:US
Mailing Address - Phone:601-484-6725
Mailing Address - Fax:601-484-5083
Practice Address - Street 1:1703 23RD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3104
Practice Address - Country:US
Practice Address - Phone:601-484-6725
Practice Address - Fax:601-484-5083
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2820-941223S0112X, 204E00000X
MSOS-339-00174400000X
MS168431223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No174400000XOther Service ProvidersSpecialist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123549Medicaid
MS704900OtherUNITED CONCORDIA
MSP00618912OtherMEDICARE PTAN
MSH38190Medicare UPIN