Provider Demographics
NPI:1912987819
Name:NEILL, JAMES SIMEON ADAMS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SIMEON ADAMS
Last Name:NEILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 EASTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2825
Mailing Address - Country:US
Mailing Address - Phone:601-984-1530
Mailing Address - Fax:601-984-1531
Practice Address - Street 1:106 EASTHAVEN DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2825
Practice Address - Country:US
Practice Address - Phone:601-984-1530
Practice Address - Fax:601-984-1531
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08398207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06172073Medicaid
MSP01402418OtherRR MEDICARE
MSD89889Medicare UPIN
MS353036YJ5DMedicare PIN
MS06172073Medicaid