Provider Demographics
NPI:1801896741
Name:COYLE, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:COYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:550 DECATUR CARTHAGE RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MS
Mailing Address - Zip Code:39327-9002
Mailing Address - Country:US
Mailing Address - Phone:601-480-8316
Mailing Address - Fax:
Practice Address - Street 1:25117 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MS
Practice Address - Zip Code:39365-9088
Practice Address - Country:US
Practice Address - Phone:601-774-8214
Practice Address - Fax:601-774-9102
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0043074208M00000X
CO43074207Q00000X
MS19451208M00000X
GA052059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06872882Medicaid
GA000679907Medicaid
GA000679907Medicaid
GA08BDJTWMedicare ID - Type Unspecified
MS6872882Medicare PIN
AL9910911Medicare PIN