Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 29081 | MS |
NPI | 1114330180 |
---|---|
Provider Name | Dr. John Chalmers Neill JR. |
First Address | Tupelo, MS 38801-4934 |
Second Address | Tupelo, MS 38801-4934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2014 |
Last Update Date | 22/07/2021 |