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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
11854 | MS | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MS | MEDICARE RAILROAD | 220009143 | 01 |
MS | 00111275 | 05 |
Address | Telephone Number | Fax Number |
---|---|---|
2301 S Lamar Blvd, Oxford, MS 386555373 | 6622328121 | 6622365236 |
Street Address |
1100 BELK BLVD |
City | OXFORD |
State | MS |
Zip Code | 38655-5242 |
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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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 Code | 207ZP0102X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pathology |
Specialization | Anatomic Pathology & Clinical Pathology |
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. |
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 |
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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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.