Healthcare Provider Details

I. General information

NPI: 1720213069
Provider Name (Legal Business Name): REDDIX MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5903 RIDGEWOOD RD SUITE 310
JACKSON MS
39211-3700
US

IV. Provider business mailing address

5903 RIDGEWOOD RD SUITE 310
JACKSON MS
39211-3700
US

V. Phone/Fax

Practice location:
  • Phone: 601-899-3310
  • Fax: 601-899-3314
Mailing address:
  • Phone: 601-899-3310
  • Fax: 601-899-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateMS

VIII. Authorized Official

Name: MS. GLORIA GRENNELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-899-3310