Emmanuel Delase Agbeti, M.D
Individual provider Active NPI Family Medicine Physician · Jackson, MS
NPI 1124815352 · NPPES record last updated Aug 14, 2025
Key facts
- NPI
- 1124815352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- T-5939 (MS)
- Practice address
- 2500 North State Street
Jackson, MS 39216 - Phone
- (601) 984-5426
- NPI assigned
- Apr 22, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251122001201 | MS | Order and Referring Only - Family Practice |
5991297442 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-5939 | MS | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | T-5939 | MS | Yes |
Addresses
Primary practice location
2500 North State Street
Jackson, MS 39216
Mailing address
2500 North State Street
Jackson, MS 39216
Other providers in Jackson, MS
- Afnb Home Care LLC
- Afnb Home Care LLC
- Sabahat Afshan
- Agape Medical Services
- Nayan Agarwal
- Joshua Agee
- Agilitas USA Inc
- James Graham Ahlrich
- Bilal Ahmad
- Syed Sameer Ahmad
All providers in Jackson, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.