DR. VIRGIL ISAAC AULTMAN (NPI# 1922006279) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922006279 |
| Entity Type | Individual |
| Full Name | DR. VIRGIL ISAAC AULTMAN |
| Credential | MD |
| Practice Address |
2747 Old Canton Rd Jackson MS 39216-4308 |
| Practice Telephone | 6013666452 |
| Practice Fax Number | 6013666488 |
| Mailing Telephone | 6013666452 |
| Mailing Fax Number | 6013666488 |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2010-03-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
06153 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00013576 | 05 |
| Street Address |
2747 OLD CANTON RD |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821032392 | Rachel Antonia Jones | Family Medicine | 866 Medical Plz, Jackson, MS 39204-4948 | 2006-06-15 |
| 1124072723 | Lynda Catherine Hammond | Family Medicine | 517 Wildwood Ave, Suite B, Jackson, MI 49201-1044 | 2006-05-19 |
| 1023078128 | Robert D. Langer | Family Medicine | 555 E. Broadway, Suite 108, Jackson, WY 83001 | 2006-03-24 |
| 1356856561 | Cassandra Amos Walters | Family Medicine | 1850 Chadwick Dr, Jackson, MS 39204-3404 | 2017-12-11 |
| 1700076940 | Aqfa Sultana | Family Medicine | 3502 W Northside Dr, Jackson, MS 39213-4454 | 2007-07-25 |
| 1679773113 | Rajvinder Singh Hanspal | Family Medicine | 1815 Hospital Dr, Jackson, MS 39204-3425 | 2007-07-23 |
| 1942341714 | Billy Ray Register | Family Medicine | 5002 Hwy 10, Jackson, LA 70748-0438 | 2007-02-12 |
| 1629179171 | Larry D Farr | Family Medicine | 3235 E Michigan Ave, Jackson, MI 49202-3971 | 2006-09-26 |
| 1770519142 | Debra Rice | Family Medicine | 3502 W Northside Dr, Jackson, MS 39213-4454 | 2006-06-25 |
| 1699718700 | Weymoth Crowell | Family Medicine | 3502 W Northside Dr, Jackson, MS 39213-4454 | 2006-06-14 |
| Find all providers in JACKSON | ||||
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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.