MR. JIMMIE G MOORE JR. (NPI# 1144255225) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144255225 |
| Entity Type | Individual |
| Full Name | MR. JIMMIE G MOORE JR. |
| Credential | PA-C |
| Practice Address |
3688 Veterans Memorial Dr Suite 200 Hattiesburg MS 39401-8246 |
| Practice Telephone | 6015547400 |
| Practice Fax Number | 6015547488 |
| Mailing Telephone | 6015547400 |
| Mailing Fax Number | 6015547488 |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2010-01-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA028 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 02274715 | 05 |
| Street Address |
3688 VETERANS MEMORIAL DR SUITE 200 |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-8246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912906157 | Southern Surgery Center, LLC | Clinic/Center | 3688 Veterans Memorial Dr, Suite 100, Hattiesburg, MS 39401-8246 | 2005-07-19 |
| 1548883200 | Emily Mcdermott | Physical Therapist | 3688 Veterans Memorial Dr, Hattiesburg, MS 39401-8246 | 2020-05-28 |
| 1851924013 | Melissa Ann Ezelle | Registered Nurse | 3688 Veterans Memorial Dr, Hattiesburg, MS 39401-8246 | 2020-02-17 |
| 1932607132 | Kerri Michelle Easterling | Occupational Therapist | 3688 Veterans Memorial Dr, Hattiesburg, MS 39401-8246 | 2018-01-23 |
| 1174980213 | Marshall Bynum | Physician Assistant | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401-8246 | 2016-01-20 |
| 1487854295 | John J Davis | Specialist/Technologist | 3688 Veterans Memorial Dr, Hattiesburg, MS 39401-8246 | 2007-07-19 |
| 1356546295 | Southern Bone& Joint Specialists | Specialist | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401-8246 | 2007-06-20 |
| 1295937928 | John Herrington Kosko | Orthopaedic Surgery | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401-8246 | 2007-06-04 |
| 1952523607 | Frederick O'neal Gregg | Orthopaedic Surgery | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401 | 2007-05-03 |
| 1912033291 | Sunbelt Rehabilitation Systems, LLC | Clinic/Center | 3688 Veterans Memorial Dr, Suite 300, Hattiesburg, MS 39401-8246 | 2007-02-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659781474 | Stephen Craig English Jr. | Physician Assistant | 118 College Dr Box 5066, Hattiesburg, MS 39406-0001 | 2014-05-01 |
| 1710316880 | Vani Naraharisetty | Physician Assistant | 101 Asbury Circle, Hattiesburg, MS 39402-1150 | 2013-11-08 |
| 1174980213 | Marshall Bynum | Physician Assistant | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401-8246 | 2016-01-20 |
| 1871879783 | Lorin Jones | Physician Assistant | 5001 Hardy St, Hattiesburg, MS 39402-1308 | 2011-10-25 |
| 1538246921 | Benjamin M Yelverton | Physician Assistant | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401-8246 | 2006-11-01 |
| 1467479550 | Jerry Lee Stork | Physician Assistant | 3688 Veterans Memorial Dr, 200, Hattiesburg, MS 39401-8246 | 2006-07-16 |
| 1083647960 | Clifton H Davis | Physician Assistant | 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401-8246 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679931083 | Heather M Anderson | Physician Assistant | 2080 S Frontage Rd Ste 100, Vicksburg, MS 39180 | 2016-02-01 |
| 1962804211 | Miranda Street Sudduth | Physician Assistant | 1607 Doctors Drive, Madison, MS 39110 | 2014-09-18 |
| 1417194978 | Bolivar Emergency Group LLC | Physician Assistant | 901 Hwy 8 East Sunflower Rd, Cleveland, MS 38732 | 2009-01-20 |
| 1083878243 | Garrett Miller | Physician Assistant | 81 Mdg (aetc), 301 Fisher St, Keelser Afb, MS 39534 | 2008-07-16 |
| 1891979597 | Franklin Mcgrew | Physician Assistant | 22689 Highway 63 North, Leakesville, MS 39451 | 2007-12-18 |
| 1851421192 | Angela Marie Dauro | Physician Assistant | 147 Reynoir St Ste 200, Biloxi, MS 39530-4121 | 2007-03-06 |
| 1952441941 | Donald E Stanford | Physician Assistant | 142 County Road 1548, Saltillo, MS 38866-9006 | 2007-02-07 |
| 1144301458 | Ashley J Larsen | Physician Assistant | 2a Doctors Dr, Ocean Springs, MS 39564-5721 | 2006-10-17 |
| 1013966969 | Angelle P Lowery | Physician Assistant | 1137 Ocean Springs Rd, Ocean Springs, MS 39564-3421 | 2006-05-09 |
| 1801866736 | Carlson D Moss | Physician Assistant | Naval Branch Medical Clinic Pascagoula, Pascagoula, MS 39595-0001 | 2006-01-24 |
| Find all providers with the same taxonomy | ||||
| City | HATTIESBURG |
| Zip Code | 39401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.