Provider Demographics
NPI:1073124194
Name:RALPH, AISHA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:RALPH
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5107 ROMANY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4836
Mailing Address - Country:US
Mailing Address - Phone:706-951-7511
Mailing Address - Fax:737-910-1331
Practice Address - Street 1:2080 DUNBARTON DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5016
Practice Address - Country:US
Practice Address - Phone:706-945-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife