Healthcare Provider Details

I. General information

NPI: 1922940204
Provider Name (Legal Business Name): JESSICA VIRGINIA MEREDITH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30117 SCHOENHERR RD STE 400
WARREN MI
48088-6854
US

IV. Provider business mailing address

30117 SCHOENHERR RD STE 400
WARREN MI
48088-6854
US

V. Phone/Fax

Practice location:
  • Phone: 586-738-9470
  • Fax: 586-738-9469
Mailing address:
  • Phone: 586-738-9470
  • Fax: 586-738-9469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: