Basic Information
| Provider Information | |||||||||
| NPI: | 1336242239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERKINS | ||||||||
| FirstName: | ISSAC | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 FLOWOOD DR STE 402 | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013762832 | ||||||||
| FaxNumber: | 6019361260 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 CHADWICK DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392043404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013762832 | ||||||||
| FaxNumber: | 6019361260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 10/09/2018 | ||||||||
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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 | 207R00000X | 11304 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 11304 | MS | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 03559373 | 05 | MS | MEDICAID | P01237616 | 01 | MS | RAILROAD MEDICARE | OTHER |