Provider Demographics
NPI:1992998124
Name:FARMER AND ASSOCIATES INTERNAL MEDICINE
Entity type:Organization
Organization Name:FARMER AND ASSOCIATES INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:601-376-2791
Mailing Address - Street 1:1860 CHADWICK DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3463
Mailing Address - Country:US
Mailing Address - Phone:601-376-2791
Mailing Address - Fax:601-376-2792
Practice Address - Street 1:1860 CHADWICK DR
Practice Address - Street 2:SUITE 303
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3463
Practice Address - Country:US
Practice Address - Phone:601-376-2791
Practice Address - Fax:601-376-2792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16951261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty