Calvin S Ennis, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

08202 Issued in MS

Practice address

8006 Hwy 613
Moss Point, MS 39562

Phone

(228) 475-1166

Fax

(228) 475-9337

NPI assigned

Sep 22, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144320920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1358",
            "city": "ESCATAWPA",
            "state": "MS",
            "postal_code": "395521358",
            "telephone_number": "228-475-1166",
            "fax_number": "228-475-9337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8006 HWY 613",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "39562",
            "telephone_number": "228-475-1166",
            "fax_number": "228-475-9337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "CALVIN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "08202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00115468",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clarence E. Dubose Sr., R.PH.
• Billy Dycus Jr., NP
• Jessica Eaton
• Dunk A. Ellis III, MD
• Emmanuel Transit, LLC
• F T Inc (Feminine Touch)
• Family Care Center LLC (Pas Point Internal Medicine)
• Family Care Center LLC (Family Care Center)
• Pamila Sue Ferguson
• Steven B. Fineburg, MD

• Family Medicine Physician in Moss Point, MS
• Providers in Moss Point, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.