Healthcare Provider Details

I. General information

NPI: 1104434307
Provider Name (Legal Business Name): CHRISTINE S PEDDAPANGA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HIGHWAY 61 N STE 2400
VICKSBURG MS
39183-8246
US

IV. Provider business mailing address

PO BOX 5392
MERIDIAN MS
39302-5392
US

V. Phone/Fax

Practice location:
  • Phone: 601-883-3340
  • Fax: 601-661-0984
Mailing address:
  • Phone: 601-703-9407
  • Fax: 601-703-9283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31630
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: