Provider Demographics
NPI:1699745133
Name:MASSEY, JONATHAN H (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:H
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1501 JACKSON AVE W
Mailing Address - Street 2:PMB 222
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-2564
Mailing Address - Country:US
Mailing Address - Phone:662-232-8005
Mailing Address - Fax:662-232-8055
Practice Address - Street 1:1300 ACCESS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5209
Practice Address - Country:US
Practice Address - Phone:662-232-8005
Practice Address - Fax:662-232-8055
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2011-12-20
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Provider Licenses
StateLicense IDTaxonomies
MS13545207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125406Medicaid
F65513Medicare UPIN
MS00125406Medicaid