Provider Demographics
NPI:1053917849
Name:RIDGELAND MEDICAL CLINIC
Entity type:Organization
Organization Name:RIDGELAND MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:601-790-7711
Mailing Address - Street 1:587 HIGHWAY 51 STE T
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2567
Mailing Address - Country:US
Mailing Address - Phone:601-790-7711
Mailing Address - Fax:
Practice Address - Street 1:587 HIGHWAY 51 STE T
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2567
Practice Address - Country:US
Practice Address - Phone:601-790-7711
Practice Address - Fax:601-790-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty