Provider Demographics
NPI:1487967410
Name:JENNIFER D GHOLSON MD, LLC
Entity type:Organization
Organization Name:JENNIFER D GHOLSON MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-276-7665
Mailing Address - Street 1:804 ROBB ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-8291
Mailing Address - Country:US
Mailing Address - Phone:601-276-7665
Mailing Address - Fax:601-276-7655
Practice Address - Street 1:804 ROBB ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666-8291
Practice Address - Country:US
Practice Address - Phone:601-276-7665
Practice Address - Fax:601-276-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty