Provider Demographics
NPI:1689217978
Name:SPRINGRIDGE MEDICAL CLINIC
Entity Type:Organization
Organization Name:SPRINGRIDGE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:SHINITA
Authorized Official - Middle Name:REED
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-213-7681
Mailing Address - Street 1:507 SPRINGRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5628
Mailing Address - Country:US
Mailing Address - Phone:601-708-1414
Mailing Address - Fax:601-708-1415
Practice Address - Street 1:507 SPRINGRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5628
Practice Address - Country:US
Practice Address - Phone:601-708-1414
Practice Address - Fax:601-708-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-20
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty