Basic Information
| Provider Information | |||||||||
| NPI: | 1912987819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEILL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | SIMEON ADAMS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 EASTHAVEN DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390422825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019841530 | ||||||||
| FaxNumber: | 6019841531 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 EASTHAVEN DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390422825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019841530 | ||||||||
| FaxNumber: | 6019841531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 08398 | MS | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 06172073 | 05 | MS | MEDICAID | P01402418 | 01 | MS | RR MEDICARE | OTHER |