SUMNER B DOUGLAS


Address: 401 Baptist Dr Ste 1040, Madison, MS 39110-2009
Phone: 6016052383

SUMNER B DOUGLAS (NPI# 1548821333) 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) 1548821333
Entity Type Individual
Full Name SUMNER B DOUGLAS
Credential NP
Practice Address 401 Baptist Dr Ste 1040
Madison
MS 39110-2009
Mailing Address 965 Ridge Lake Blvd Ste 103
Memphis
TN 38120-9446
Practice Telephone 6016052383
Practice Fax Number 6016053898
Mailing Telephone 9012261613
Mailing Fax Number 9012278591
Enumeration Date 2019-06-24
Last Update Date 2020-09-25
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LF0000X Nurse Practitioner
Specialization: Family
903149 MS Physician Assistants & Advanced Practice Nursing Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
1340 Broad Ave Ste 320, Gulfport, MS 395012464 2285751775 2285751770

Office Location

Street Address 401 BAPTIST DR STE 1040
City MADISON
State MS
Zip Code 39110-2009

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
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1912488198 Madison Medical Compounding Pharmacy Pharmacy 111 Fountains Blvd. Building B Ste. A, Madison, MS 39110 2018-08-24
1679061469 Nuvena Vein Clinic Anesthesiology 120 Fountains Blvd, Madison, MS 39110 2018-04-26
1467960484 Brick City Drugs, LLC Durable Medical Equipment & Medical Supplies 159 Fountains Blvd, Madison, MS 39110 2018-01-11
1093227589 Hannah Monk Hawthorne Counselor 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 2017-10-25
1548786650 Kimberly Allen Pharmacist 1100 Us- 51, Madison, MS 39110 2017-08-21
1891218186 Delta Elizabeth Stark Chiropractor 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 2017-07-19
1861914848 Laura Hartlein Dietitian, Registered 200 Park Circle Dr. #2, Flowood, MS 39110 2017-07-12
1831620608 Ona Irby Occupational Therapist 105 Munich Dr, Madison, MS 39110 2017-03-23
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
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1942865365 Marta Cooper Nurse Practitioner 579 Donofrio Dr Ste 1, Madison, WI 53719-2838 2019-05-02
1215490024 Angela Wiggins Nurse Practitioner 1210 Briarville Rd Bldg B, Madison, TN 37115-5136 2019-04-09
1124585419 Melissa Kay Albright Nurse Practitioner 44 Hughes Rd Ste 2500, Madison, AL 35758-3026 2019-02-22
1912475393 Katlynn Ann Kelley Nurse Practitioner 20 S Park St Rm M417, Madison, WI 53715-1348 2018-11-05
1053887943 Denita Ward Nurse Practitioner 2145 Fox Ave, Madison, WI 53711-1920 2018-10-17
1992203079 Brandy J Smith Nurse Practitioner 703 Green Rd Ste 1, Madison, IN 47250-2145 2018-01-24
1447769468 Cynthia Kline O'sullivan Nurse Practitioner 30 Highview Rd, Madison, CT 06443-2554 2017-09-21
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Competitor

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City MADISON
Zip Code 39110

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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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