Active NPI
Thomas G Puckett, MD
- Anatomic Pathology & Clinical Pathology Physician
- Hattiesburg, MS
National Provider Identifier
1841308160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 06231
- Practice address
- 1107 S 34TH Ave
Hattiesburg, MS 39402-3004 - Phone
- (601) 268-1988
- NPI assigned
- Aug 27, 2006
- 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 |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 06231 | MS | Primary |
Addresses
Primary practice location
1107 S 34TH Ave
Hattiesburg, MS 39402-3004
Mailing address
1107 S 34TH Ave
Hattiesburg, MS 39402-3004
Phone (601) 268-1988
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00120180 | Medicaid | MS | |
| 009924610 | Medicaid | AL | |
| 1559101 | Other | MS | AMERICAN ADMIN GROUP |
| 1561274 | Medicaid | LA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dpuckett4730@directpatientrecord.com | Health Information Exchange (HIE) |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- dpuckett4730@directpatientrecord.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659484800000",
"number": "1841308160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1107 S 34TH AVE",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394023004",
"telephone_number": "601-268-1988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1107 S 34TH AVE",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394023004",
"telephone_number": "601-268-1988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "THOMAS",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-27",
"last_updated": "2022-08-03",
"certification_date": "2022-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MS",
"license": "06231",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00120180",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009924610",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN ADMIN GROUP",
"identifier": "1559101",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1561274",
"state": "LA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dpuckett4730@directpatientrecord.com",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "421 S 28th Ave",
"city": "Hattiesburg",
"state": "MS",
"country_code": "US",
"postal_code": "394017236",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.