Provider Demographics
NPI:1396700811
Name:JAMESON, REBECCA (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:JAMESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 HARDY ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1308
Mailing Address - Country:US
Mailing Address - Phone:601-261-5744
Mailing Address - Fax:601-261-5716
Practice Address - Street 1:4891 HIGHWAY 589
Practice Address - Street 2:
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482-3954
Practice Address - Country:US
Practice Address - Phone:601-758-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118650Medicaid
MS00118650Medicaid
MSG86741Medicare UPIN