Healthcare Provider Details

I. General information

NPI: 1659472488
Provider Name (Legal Business Name): GREATER MERIDIAN HEALTH CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 DAVIS ST
MERIDIAN MS
39301-5708
US

IV. Provider business mailing address

2701 DAVIS ST
MERIDIAN MS
39301-5708
US

V. Phone/Fax

Practice location:
  • Phone: 601-693-0118
  • Fax: 844-778-8922
Mailing address:
  • Phone: 601-693-0118
  • Fax: 601-693-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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