Healthcare Provider Details

I. General information

NPI: 1841397189
Provider Name (Legal Business Name): GREATER MERIDIAN HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 MILLERS CHAPEL CHURCH RD
MACON MS
39341
US

IV. Provider business mailing address

2701 DAVIS ST
MERIDIAN MS
39301-5708
US

V. Phone/Fax

Practice location:
  • Phone: 662-793-4845
  • Fax: 844-778-8922
Mailing address:
  • Phone: 601-693-0118
  • Fax: 601-553-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: WILBERT L. JONES
Title or Position: CEO
Credential:
Phone: 601-693-0118