Provider Demographics
NPI:1184663528
Name:RICKS, BARBARA L (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:RICKS
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 1:1693 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7810
Mailing Address - Country:US
Mailing Address - Phone:662-725-2749
Mailing Address - Fax:662-725-2741
Practice Address - Street 1:526 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-5401
Practice Address - Country:US
Practice Address - Phone:662-332-0501
Practice Address - Fax:662-332-0176
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16166208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1550787Medicaid
MS00120460Medicaid
H43188Medicare UPIN
MS370000408Medicare PIN