Southern Primary Care PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SOUTHERN PRIMARY CARE PLLC

Practice address

511 Brookman Dr
Brookhaven, MS 39601-2326

Phone

(601) 833-3800

Fax

(601) 833-3847

NPI assigned

Jul 20, 2011

Last updated

Jul 20, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert K Walker, MDNPI 1225205313

Title

Owner/President

Phone

(601) 833-3800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marty Kyle Ballard Sr., FNP

  • Family Nurse Practitioner
  • Brookhaven, MS
  • NPI 1023622081
  Medicare reassignment Care Compare group NPD
• Haley Mitchell, FNP-C

  • Family Nurse Practitioner
  • Brookhaven, MS
  • NPI 1538047949
  Medicare reassignment Care Compare group NPD
• Robert Kenneth Walker, MD

  • Emergency Medicine Physician
  • Brookhaven, MS
  • NPI 1225205313
  Authorized official Same address or phone
• Blaine Cooper Britt, M.D.

  • Internal Medicine Physician
  • Brookhaven, MS
  • NPI 1255593265
  NPD (past)
• Mary Lindsey Lumley

  • Psychiatric/Mental Health Nurse Practitioner
  • Brookhaven, MS
  • NPI 1093329633
  NPD (past)

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

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311120000000",
    "number": "1891083135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 BROOKMAN DR",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012326",
            "telephone_number": "601-833-3800",
            "fax_number": "601-833-3847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 BROOKMAN DR",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012326",
            "telephone_number": "601-833-3800",
            "fax_number": "601-833-3847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-20",
        "last_updated": "2011-07-20",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "601-833-3800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Mississippi Home Health Inc - Region II (Deaconess HomeCare)
• South Mississippi Home Health, Inc. (Deaconess Hospice)
• South Mississippi Wound Management LLC (South Mississippi Wound Management)
• Southern Bone & Joint Specialists
• Southern Foot Care Inc
• Southern Surgical Services, LLC
• Southerncare, Inc. (Gentiva)
• Southwest Ms Nephrology, PLLC
• Southwest Pharmacy Inc (Guy's Pharmacy of Brookhaven)
• Jacob Warren Spring, FNP

• Family Medicine Physician in Brookhaven, MS
• Providers in Brookhaven, 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 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.