Patriot Healthcare of Mississippi, LLC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

PATRIOT HEALTHCARE OF MISSISSIPPI, LLC

Practice address

4800 Lakeland Drive
Flowood, MS 39232

Phone

(228) 563-4787

NPI assigned

Nov 15, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David A. Culver

Title

Administrator

Phone

(904) 825-4368

Specialties & licenses 1

Addresses

Other names 1

• PHC of MS Jackson Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542240000000",
    "number": "1104395565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ARRICOLA AVENUE",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "32080",
            "telephone_number": "904-825-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 LAKELAND DRIVE",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "39232",
            "telephone_number": "228-563-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRIOT HEALTHCARE OF MISSISSIPPI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-15",
        "last_updated": "2018-11-15",
        "status": "A",
        "authorized_official_last_name": "CULVER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-825-4368"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHC of MS Jackson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer W Pate, NP
• Ami R Patel, MD
• Kinjal Patel
• Vipin S Patel, MD
• Lyndsey M Patrick, CRNA
• Taylor Patterson Patterson Geddie, M.D.
• Consuelo Patterson, NP
• Nekeitra Patterson, MT
• George E Patton Jr., M.D.
• Joel G Payne Jr., MD

• Geriatric Medicine (Family Medicine) Physician in Flowood, MS
• Providers in Flowood, MS by specialty
• Geriatric Medicine (Family Medicine) Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.