Provider Demographics
NPI:1619981107
Name:REDDIX, CARL M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:M
Last Name:REDDIX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5903 RIDGEWOOD ROAD, SUITE 310
Mailing Address - Street 2:REDDIX MEDICAL GROUP
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3702
Mailing Address - Country:US
Mailing Address - Phone:601-899-3310
Mailing Address - Fax:601-899-3314
Practice Address - Street 1:5903 RIDGEWOOD ROAD, SUITE 310
Practice Address - Street 2:REDDIX MEDICAL GROUP
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3702
Practice Address - Country:US
Practice Address - Phone:601-899-3310
Practice Address - Fax:601-899-3314
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS12068207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00011019Medicaid
MS160000179Medicare ID - Type Unspecified
MS00011019Medicaid