| Picayune Internal Medicine | |
|
200 Golf Course Dr Carriere MS 39426-9037 | |
| (601) 699-9846 | |
| Not Available |
| Full Name | Picayune Internal Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 Golf Course Dr, Carriere, Mississippi |
| Authorized Official Name and Position | Jamie Wilson (OFFICE MANAGER) |
| Authorized Official Contact | 6016999846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Picayune Internal Medicine 200 Golf Course Dr Carriere MS 39426-9037 Ph: (601) 699-9846 | Picayune Internal Medicine 200 Golf Course Dr Carriere MS 39426-9037 Ph: (601) 699-9846 |
| NPI Number | 1033846068 |
|---|---|
| Provider Enumeration Date | 08/01/2022 |
| Last Update Date | 08/01/2022 |
| Certification Date | 08/01/2022 |
| Medicare PECOS PAC ID | 0648654632 |
|---|---|
| Medicare Enrollment ID | O20220824002993 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033846068 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Ahmad a Haidar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407837503 PECOS PAC ID: 1254426760 Enrollment ID: I20091026000141 |
| Provider Name | Jonathan S Cagle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659963882 PECOS PAC ID: 7113329962 Enrollment ID: I20210715002619 |
| Provider Name | Tammy Ruth Ferrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194522144 PECOS PAC ID: 4486139177 Enrollment ID: I20260331001820 |
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