Individual
JOERDAN RICKETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
067740
GA
208000000X
Pediatrics Physician
Primary
107059
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002671100
—
FL
05
—
003124270A
—
GA
Enumeration date
02/08/2010
Last updated
03/31/2016
Update your record
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