Provider Demographics
NPI:1770699670
Name:SOJOURNER, DENISE HEFNER (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:HEFNER
Last Name:SOJOURNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:HEFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1065
Mailing Address - Street 2:359 OLD OAK CIRCLE
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-1065
Mailing Address - Country:US
Mailing Address - Phone:662-489-5999
Mailing Address - Fax:662-489-5991
Practice Address - Street 1:359 OLD OAK CIR
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-5016
Practice Address - Country:US
Practice Address - Phone:662-489-5999
Practice Address - Fax:662-489-5991
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122628Medicaid
080003311Medicare ID - Type Unspecified
MS00122628Medicaid