Basic Information
| Provider Information | |||||||||
| NPI: | 1427071919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PURVIS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 SGT PRENTISS DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391204792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014423701 | ||||||||
| FaxNumber: | 6014424785 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 SGT PRENTISS DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391204792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014423701 | ||||||||
| FaxNumber: | 6014424785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 10/04/2012 | ||||||||
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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 | 207VG0400X | 05717 | MS | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00115423 | 05 | MS | MEDICAID | 1104604 | 05 | LA | MEDICAID |