Provider Demographics
NPI:1114127222
Name:MEREDITH, COURTNEY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 REYNOIR ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-4109
Mailing Address - Country:US
Mailing Address - Phone:228-436-6658
Mailing Address - Fax:
Practice Address - Street 1:147 REYNOIR ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4109
Practice Address - Country:US
Practice Address - Phone:228-436-6658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21437207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR9499Medicaid