Provider Demographics
NPI:1720094196
Name:BROOKINS-REDDIX, NATALIE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:BROOKINS-REDDIX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5903 RIDGEWOOD RD
Mailing Address - Street 2:SUITE 310, 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
Practice Address - Street 2:SUITE 310, 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:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00012689Medicaid
MS110000461Medicare ID - Type Unspecified
MS00012689Medicaid