Basic Information
| Provider Information | |||||||||
| NPI: | 1336118843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | GUY | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 405827 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303845827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709345821 | ||||||||
| FaxNumber: | 8709345384 | ||||||||
| Practice Location | |||||||||
| Address1: | 232 STARLYN AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386522428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6625345891 | ||||||||
| FaxNumber: | 6625345970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 14294 | MS | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208600000X | 02002767A | IN | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 14294 | MS | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200482400 | 05 | IN | MEDICAID | 05924350 | 05 | MS | MEDICAID | 11484466 | 01 | IN | CAQH NUMBER | OTHER | 9397057 | 01 | IN | PHCS PID NUMBER | OTHER | 000000333616 | 01 | IN | ANTHEM PROVIDER NUMBER | OTHER |