Provider Demographics
NPI:1083985303
Name:GINES, TONY
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:GINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HIGHLAND COLONY PKWY
Mailing Address - Street 2:SUITE 5203
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2073
Mailing Address - Country:US
Mailing Address - Phone:601-427-4734
Mailing Address - Fax:601-427-4735
Practice Address - Street 1:1000 HIGHLAND COLONY PKWY
Practice Address - Street 2:SUITE 5203
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2073
Practice Address - Country:US
Practice Address - Phone:601-427-4734
Practice Address - Fax:601-427-4735
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center