Provider Demographics
NPI:1821291790
Name:WADSWORTH, MARGARET E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:E
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:970 LAKELAND DR
Mailing Address - Street 2:SUITE 34
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4635
Mailing Address - Country:US
Mailing Address - Phone:601-362-0600
Mailing Address - Fax:601-362-1186
Practice Address - Street 1:1225 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2064
Practice Address - Country:US
Practice Address - Phone:601-968-1416
Practice Address - Fax:601-968-1218
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS210132085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04535864Medicaid
MS1821291790OtherNPI
GAXXXXXXX23OtherRAILROAD MEDICARE
MS004535864Medicaid
MS12158580OtherCAQH