Provider Demographics
NPI:1174614895
Name:HUNTWORK, JOHN CHURCHILL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHURCHILL
Last Name:HUNTWORK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 HOSPITAL ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5320
Mailing Address - Country:US
Mailing Address - Phone:228-696-9995
Mailing Address - Fax:
Practice Address - Street 1:4211 HOSPITAL ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5320
Practice Address - Country:US
Practice Address - Phone:228-696-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15215207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117902Medicaid
MSA71981Medicare UPIN
MS00117902Medicaid