Provider Demographics
NPI:1629003702
Name:MEEKS, GEORGE RODNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RODNEY
Last Name:MEEKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5373
Mailing Address - Fax:601-984-5476
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5373
Practice Address - Fax:601-984-5476
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7036207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS160022723OtherRR MEDICARE NUMBER
MS08103071OtherUP MEDICAID GROUP NUMBER
MSP00679675OtherUP RR MEDICARE PTAN#
MS00016026Medicaid
MS512I160011OtherMEDICARE PTAN
MS512G700003OtherUP MEDICARE GROUP PROV #
MSP01149223Medicare PIN
MS160022723OtherRR MEDICARE NUMBER
MS08103071OtherUP MEDICAID GROUP NUMBER
MSC00319Medicare ID - Type UnspecifiedMCRE GROUP PROV NUMBER
MS162945618Medicare ID - Type UnspecifiedMCRE INDV PROV NUMBER