Basic Information
| Provider Information | |||||||||
| NPI: | 1275943037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALHOUN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23666 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392253666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012002780 | ||||||||
| FaxNumber: | 6012002788 | ||||||||
| Practice Location | |||||||||
| Address1: | 971 LAKELAND DR STE 657 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012002780 | ||||||||
| FaxNumber: | 6012002788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2014 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CT | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208G00000X | 26975 | MS | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 07583261 | 05 | MS | MEDICAID | 26975 | 01 | MS | MS MEDICAL LICENSE | OTHER | 1R9597 | 01 | MS | MEDICARE ST DOM | OTHER |