Provider Demographics
NPI:1780887133
Name:JCEP,PLLC,
Entity type:Organization
Organization Name:JCEP,PLLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:OLUSOLA
Authorized Official - Last Name:OKUNOREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-923-6200
Mailing Address - Street 1:PO BOX 1992
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-1992
Mailing Address - Country:US
Mailing Address - Phone:601-923-6200
Mailing Address - Fax:601-923-9111
Practice Address - Street 1:2147 HENRY HILL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-2001
Practice Address - Country:US
Practice Address - Phone:601-923-6200
Practice Address - Fax:601-923-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty