Provider Demographics
NPI:1841284478
Name:RICKS, JANET L (DO)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:L
Last Name:RICKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:L
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:878 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4644
Mailing Address - Country:US
Mailing Address - Phone:601-984-6800
Mailing Address - Fax:601-984-6812
Practice Address - Street 1:878 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4644
Practice Address - Country:US
Practice Address - Phone:601-984-6800
Practice Address - Fax:601-984-6812
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080172477OtherRAILROAD MEDICARE
MS0012406Medicaid
73005589OtherBLUE CROSS OF AL
MSP00462314OtherRAILROAD MEDICARE - UP
MS0012406Medicaid
MS080003447Medicare ID - Type Unspecified
H38299Medicare UPIN