Healthcare Provider Details

I. General information

NPI: 1841284478
Provider Name (Legal Business Name): JANET L. RICKS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JANET L. PRICE D.O.

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

878 LAKELAND DR
JACKSON MS
39216-4644
US

IV. Provider business mailing address

878 LAKELAND DR
JACKSON MS
39216-4644
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6800
  • Fax: 601-984-6812
Mailing address:
  • Phone: 601-984-6800
  • Fax: 601-984-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16441
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: