Provider Demographics
NPI:1568523140
Name:DOXEY, SEDJINON GARDNER
Entity Type:Individual
Prefix:MRS
First Name:SEDJINON
Middle Name:GARDNER
Last Name:DOXEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 PARKWAY CIR
Mailing Address - Street 2:
Mailing Address - City:TOOMSUBA
Mailing Address - State:MS
Mailing Address - Zip Code:39364-9774
Mailing Address - Country:US
Mailing Address - Phone:601-693-8679
Mailing Address - Fax:
Practice Address - Street 1:721 FRONT STREET EXT
Practice Address - Street 2:SUITE 732 ACME PLAZA
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4500
Practice Address - Country:US
Practice Address - Phone:601-482-4003
Practice Address - Fax:601-482-3948
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-09364183500000X
AL14050183500000X
LA15827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist