Healthcare Provider Details

I. General information

NPI: 1053046201
Provider Name (Legal Business Name): GREATER MERIDIAN HEALTH CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/11/2022
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: 844-778-8922

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