Healthcare Provider Details

I. General information

NPI: 1104241660
Provider Name (Legal Business Name): ARDARIAN GILLIAM-PIERRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARDARIAN DARICE GILLIAM PIERRE MD

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 LAKELAND DR 2ND FLOOR
JACKSON MS
39216-4651
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6800
  • Fax:
Mailing address:
  • Phone: 601-815-4778
  • Fax: 601-984-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME139129
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58588
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52182
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25936
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.135457
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: