MARSHALL J BOULDIN IV (NPI# 1255364956) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255364956 |
| Entity Type | Individual |
| Full Name | MARSHALL J BOULDIN IV |
| Credential | M.D. |
| Practice Address |
1040 River Oaks Dr Suite 302 Jackson MS 39232-9530 |
| Mailing Address |
3322 W End Ave 11th Floor Nashville TN 37203-1031 |
| Practice Telephone | 6019399923 |
| Practice Fax Number | 6019399924 |
| Mailing Telephone | 6155159880 |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2014-03-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 12970 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | RAILROAD | RR 110204015 | 01 |
| MS | 00120235 | 05 |
| Street Address |
1040 RIVER OAKS DR SUITE 302 |
| City | JACKSON |
| State | MS |
| Zip Code | 39232-9530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659369494 | Amy J Olson | Dietitian, Registered | 1040 River Oaks Dr, Suite 302, Jackson, MS 39232-9530 | 2005-10-06 |
| 1689017915 | Dianna Phillips | Registered Nurse | 1040 River Oaks Dr, Suite 302, Jackson, MS 39232-9530 | 2013-04-17 |
| 1396059093 | Miss Reproductive Medicine Pllc | Obstetrics & Gynecology | 1040 River Oaks Dr, Jackson, MS 39232-9530 | 2010-08-05 |
| 1477872281 | Judith M Champion | Registered Nurse | 1040 River Oaks Dr, Ste. 302, Jackson, MS 39232-9530 | 2010-05-19 |
| 1477872273 | Toni L. Cooper | Registered Nurse | 1040 River Oaks Dr, Ste. 302, Jackson, MS 39232-9530 | 2010-05-19 |
| 1942522156 | Autumn P Douglas | Dietitian, Registered | 1040 River Oaks Dr, Ste. 302, Jackson, MS 39232-9530 | 2010-02-16 |
| 1043545874 | Yolanda Smith | Nurse Practitioner | 1040 River Oaks Dr, Suite 302, Jackson, MS 39232-9530 | 2009-10-13 |
| 1235329020 | Center of Infectious Disease Excellence | Internal Medicine | 1040 River Oaks Dr, Suite 303, Jackson, MS 39232-9530 | 2007-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164071775 | Leanna Nicole Howard | Social Worker | 2945 Layfair Drive, Apt. 1621, Flowood, MS 39232 | 2019-09-06 |
| 1104395565 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 4800 Lakeland Drive, Flowood, MS 39232 | 2018-11-15 |
| 1285101816 | Magnolia Anesthesia Consultants LLC | Anesthesiology | 4209 Lakeland Dr #252, Flowood, MS 39232 | 2018-11-01 |
| 1528543592 | Matthew T Armstrong | Physical Therapist | 104 Burney Drive, Flowood, MS 39232 | 2018-09-26 |
| 1790265627 | Mississippi Brain and Spine, Pllc | Non-Pharmacy Dispensing Site | 1 Layfair Drive, Ste 120, Flowood, MS 39232 | 2018-08-20 |
| 1629574918 | Billy Clifton Osbon Jr. | Pharmacist | 2506 Lakeland Drive, Suite 201, Flowood, MS 39232 | 2018-04-04 |
| 1356851752 | Oakdale Family Dentistry | Clinic/Center | 2139 Hwy 471, Flowood, MS 39232 | 2017-10-11 |
| 1992227177 | Charisma T. Cummings | Nurse Practitioner | 102 Riverview Drive, Suite A, Flowood, MS 39232 | 2017-07-10 |
| 1508398983 | Charles Pearson | Student in an Organized Health Care Education/Training Program | 764 Flowood Dr, Flowood, MS 39232 | 2017-04-03 |
| 1396288197 | Mary Claire Ponder | Nurse Practitioner | 151 E Metro Dr Ste 103, Flowood, MS 39232 | 2016-11-28 |
| Find all providers in zip 39232 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215556048 | Hannah Roberts Badon | Internal Medicine | 2450 Wild Valley Dr, Jackson, MS 39211-6224 | 2020-04-12 |
| 1649809476 | Rachel Horn Mullins | Internal Medicine | 5379 Fairway St, Jackson, MS 39211-4251 | 2020-04-03 |
| 1861800666 | Michigan Continuum Care Pllc | Internal Medicine | 1310 Greenwood Ave., Jackson, MI 49203 | 2014-07-25 |
| 1356605752 | Jeremy Taylor | Internal Medicine | 971 Lakeland Dr Ste 450, Jackson, MS 39216-4615 | 2012-06-29 |
| 1134416019 | Zubair Khan | Internal Medicine | 3291 Creekwood Cir, Jackson, WI 53037-8927 | 2011-06-29 |
| 1801181466 | Anne Marie Shute | Internal Medicine | 7 Windwood Dr, Jackson, TN 38305-8835 | 2011-06-12 |
| 1487945648 | Howard Carroll Friday | Internal Medicine | 4019 Old Canton Rd., Jackson, MS 39216 | 2011-04-22 |
| 1801195003 | Mahir H Alsalman | Internal Medicine | 3100 Cooper St, Jackson, MI 49201-7545 | 2011-03-28 |
| 1912138967 | Tatum Medical Clinic | Internal Medicine | 5903 Ridgewood Rd Ste 330, Jackson, MS 39211-3702 | 2009-08-06 |
| 1306089040 | Hussein Othman | Internal Medicine | 205 Page Ave Ste B, Jackson, MI 49201-2462 | 2009-04-10 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on MARSHALL J BOULDIN IV.
| 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.