Provider Demographics
NPI:1588759393
Name:BUTTS, DONALD H (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:H
Last Name:BUTTS
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 1:1920 CHADWICK DRIVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204
Mailing Address - Country:US
Mailing Address - Phone:601-373-9001
Mailing Address - Fax:601-371-0208
Practice Address - Street 1:1920 CHADWICK DRIVE
Practice Address - Street 2:SUITE 109
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204
Practice Address - Country:US
Practice Address - Phone:601-373-9001
Practice Address - Fax:601-371-0208
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018176Medicaid
MS00018176Medicaid