Active NPI
Justin Douglas
- Registered Nurse First Assistant
- Brookhaven, MS
National Provider Identifier
1073153433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse First Assistant
- License
- 854447
- Practice address
- 427 Highway 51 N
Brookhaven, MS 39601-2350 - Phone
- (601) 835-9275
- Fax
- (888) 965-6812
- NPI assigned
- Jan 13, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse First Assistant | 163WR0006X | 854447 | MS | Primary |
Addresses
Primary practice location
427 Highway 51 N
Brookhaven, MS 39601-2350
Mailing address
427 Highway 51 N
Brookhaven, MS 39601-2350
Phone (601) 835-9275
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 854447 | MS | MD | Registered Nurse First Assistant |
Interoperability endpoints
- https://api.platform.athenahealth.com/6393/brand/1/csg/41/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578873600000",
"number": "1073153433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "427 HIGHWAY 51 N",
"city": "BROOKHAVEN",
"state": "MS",
"postal_code": "396012350",
"telephone_number": "601-835-9275",
"fax_number": "888-965-6812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "427 HIGHWAY 51 N",
"city": "BROOKHAVEN",
"state": "MS",
"postal_code": "396012350",
"telephone_number": "601-835-9275",
"fax_number": "888-965-6812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-13",
"last_updated": "2020-01-13",
"certification_date": "2020-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "163WR0006X",
"taxonomy_group": "",
"desc": "Registered Nurse, Registered Nurse First Assistant",
"state": "MS",
"license": "854447",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookhaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.