Provider Demographics
NPI:1053426908
Name:SAMMS, CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:SAMMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:SAMMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:JMM SUITE 2525
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-9528
Mailing Address - Fax:601-984-6439
Practice Address - Street 1:1285 SPRING ST
Practice Address - Street 2:STE A
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3423
Practice Address - Country:US
Practice Address - Phone:228-896-6441
Practice Address - Fax:228-896-6576
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11775208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119301Medicaid
MS$$$$$$$$$OtherBCBS
MS$$$$$$$$$EOtherBCBS
MS$$$$$$$$$FOtherBCBS
MS$$$$$$$$$GOtherBCBS
MS$$$$$$$$$DOtherBCBS
MS00119301Medicaid
MS$$$$$$$$$BOtherBCBS
MS$$$$$$$$$DOtherBCBS
MS$$$$$$$$$EOtherBCBS
MS00119301Medicaid