Marvin Homer Jeter Jr., M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

05361 Issued in MS

Practice address

15 Northtown Dr
Suite G
Jackson, MS 39211-3048

Phone

(601) 956-8200

Fax

(601) 956-8100

NPI assigned

May 25, 2008

Last updated

Aug 26, 2015By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2013 through Jul 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1211673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440547200000",
    "number": "1235397423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 NORTHTOWN DR",
            "address_2": "SUITE G",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392113048",
            "telephone_number": "601-956-8200",
            "fax_number": "601-956-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 NORTHTOWN DR",
            "address_2": "SUITE G",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392113048",
            "telephone_number": "601-956-8200",
            "fax_number": "601-956-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETER",
        "first_name": "MARVIN",
        "middle_name": "HOMER",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-25",
        "last_updated": "2015-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "05361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Matthew Jennings, MD
• Tamra Danette Jerdine, LCSW
• Kathryn Lindsay Jerome, M.D.
• Jessica Lott Therapy
• Joshua Jeter, M.D.
• Katherine Marie Jett, FAMILY NURSE PRACT.
• Susan Michelle Jett, NP
• Nicholas Barranco Jew, M.D.
• Disha Jhaveri, DMD
• Tulip Jhaveri, M.D.,

• Internal Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.