DR. JOHN P FULLENWIDER


Address: 1100 Belk Blvd, Oxford, MS 38655-5242
Phone: 8003620858

DR. JOHN P FULLENWIDER (NPI# 1497938690) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1497938690
Entity Type Individual
Full Name DR. JOHN P FULLENWIDER
Credential M.D.
Practice Address 1100 Belk Blvd
Oxford
MS 38655-5242
Mailing Address Po Box 428
Oxford
MS 38655-0428
Practice Telephone 8003620858
Practice Fax Number 6625347188
Mailing Telephone 6622328121
Mailing Fax Number 6622365236
Enumeration Date 2007-12-11
Last Update Date 2020-06-23
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207ZP0102X Pathology
Specialization: Anatomic Pathology & Clinical Pathology
11854 MS Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
MS MEDICARE RAILROAD 220009143 01
MS 00111275 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
2301 S Lamar Blvd, Oxford, MS 386555373 6622328121 6622365236

Office Location

Street Address 1100 BELK BLVD
City OXFORD
State MS
Zip Code 38655-5242

Providers in the same location

NPI Name Taxonomy Address Enumeration
1295717056 Jpb Pathology, Inc Pathology 1100 Belk Blvd, Oxford, MS 38655-5242 2005-11-17
1033754148 Jennifer Dixon Registered Nurse 1100 Belk Blvd, Oxford, MS 38655-5242 2019-11-12
1477108322 Baptist Memorial Hospital North Mississippi, Inc Pharmacy 1100 Belk Blvd, Oxford, MS 38655-5242 2019-08-07
1184101149 Brody L Horne Nurse Practitioner 1100 Belk Blvd, Oxford, MS 38655-5242 2018-07-23
1023468873 Rajesh Subramanya Pediatrics 1100 Belk Blvd, Oxford, MS 38655 2016-06-13
1558719625 Samuel Thomas Harris Internal Medicine 1100 Belk Blvd, Oxford, MS 38655-5242 2016-05-31
1659779767 Comprehensive Hospitalists of Ms, LLC Hospitalist 1100 Belk Blvd, Oxford, MS 38655-5242 2014-12-06
1598182826 Patrick Louis Carr Emergency Medicine 1100 Belk Blvd, Oxford, MS 38655-5242 2014-03-25
1336563279 Sandra Campbell Tonkinson Nurse Practitioner 1100 Belk Blvd, Oxford, MS 38655-5242 2014-02-12
1225125859 Baptist Memorial Hospital North Mississippi, Inc Rehabilitation Unit 1100 Belk Blvd, Oxford, MS 38655-5242 2006-10-06
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1619585809 Oxford Treatment Center, LLC Substance Abuse Rehabilitation Facility 616 Commerce Parkway, Oxford, MS 38655 2020-07-14
1760044465 Lindsay Low Beauchamp Speech-Language Pathologist 169 Ms-6 #102, Oxford, MS 38655 2019-07-02
1861058075 Tomiko D Mackey Social Worker 100 Carriage Cove, Oxford, MS 38655 2019-05-13
1174090039 Derionne Brooks Specialist/Technologist 972 Hathorn Road, University, MS 38655 2018-10-30
1497236327 Providence Companion Care Nurse's Aide 317 Heritage Dr Ste 3b, Oxford, MS 38655 2018-08-28
1255817292 Marcela Caroline Weber Counselor 152 Mississippi 7 South, Oxford, MS 38655 2018-07-12
1649775123 Oxford Outpatient Center, LLC Clinic/Center 611 Commerce Pkwy, Oxford, MS 38655 2018-03-27
1073039962 Sharon Yvette Holloway Social Worker 152 Hwy and South, Oxford, Ms 38655, Oxford, MS 38655 2017-08-22
1447774682 Courtney M Purvis Physical Therapist 300 Enterprise Dr Ste B, Oxford, MS 38655 2017-07-31
1649716580 Taylor Lynn Smith Counselor 152 Ms-7, Oxford, MS 38655 2017-01-17
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Taxonomy Information

Taxonomy Code 207ZP0102X
Grouping Allopathic & Osteopathic Physicians
Classification Pathology
Specialization Anatomic Pathology & Clinical Pathology

Taxonomy Definition

A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1073048872 Minqian Shen Pathology 616 S College Ave, Apt 106, Oxford, OH 45056-2280 2017-04-29
1780787143 Lisa Chandler Pathology 1207 Office Park Dr., Suite A, Oxford, MS 38655 2006-09-07
1295717056 Jpb Pathology, Inc Pathology 1100 Belk Blvd, Oxford, MS 38655-5242 2005-11-17
1578717674 Histology Cytology Technical Lab of North Mississippi Pathology 2301 S Lamar Blvd, Oxford, MS 38655-5373 2008-11-17
1003024613 Julie Tremor Hicks Pathology 2301 S Lamar Blvd, Jpb Pathology, Oxford, MS 38655-5373 2007-05-18
1083628689 William Mason Poston Pathology 2301 S Lamar Blvd, Oxford, MS 38655 2006-07-28
1235190356 Nicholas A Maruniak Pathology 12109 Cr 103, Oxford, FL 34484 2006-03-29

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1356497416 Jerry Pascall Moore Pathology 146 Road 83, Tupelo, MS 38801-6971 2007-01-25
1477601177 Forrest County General Hospital Pathology 300 S 29th Ave, Hattiesburg, MS 39401-7127 2007-01-08
1417027376 Brad Elliot Wheeler Pathology 300 Fisher Street, Biloxi, MS 39534 2006-11-08
1003904012 Susan Strong Cannon Pathology 15 Summer Trace Blvd, Laurel, MS 39440-2510 2006-10-11
1386738920 Celeste Lois Cook-glenn Pathology 413 Audubon Ct, Madison, MS 39110-6910 2006-10-03
1497849533 Midsouth Pathology Associates Pathology 105 Lower Woodville Rd, Natchez, MS 39120 2006-10-03
1215049929 Clay Broders Calcote Pathology 1500 E Woodrow Wilson Dr, Jackson, MS 39216-5116 2006-08-31
1548206501 James W Lewis Pathology 123 Main St N, Amory, MS 38821-3416 2006-06-20
1174565469 Vettaikorumakankav V Vedanarayanan Pathology 401 Baptist Dr Ste 301, Madison, MS 39110-2012 2006-06-12
1861464760 Turner L Willis Pathology 305 Rawls Dr, Mccomb, MS 39648-2833 2006-02-03
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Competitor

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City OXFORD
Zip Code 38655

Improve Information

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Dataset Information

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.

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