Organization
RIDGEWOOD CLINICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISHAN K. GUPTA M.D. (PHYSICIAN)
(601) 957-3211
Entity
Organization
Contact information
Practice address
1059 RIDGEWOOD CLINIC, JACKSON, MS 39211
(601) 957-3211
(601) 957-9753
Mailing address
1059 RIDGEWOOD CLINIC, JACKSON, MS 39211
(601) 957-3211
(601) 957-9753
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
12941
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013996
—
MS
Enumeration date
04/16/2007
Last updated
08/27/2014
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