Organization
WESLEY DEE GRANGER, M.D., P.A.
Active
Other names
Madison-Ridgeland Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY DEE GRANGER M.D. (OWNER)
(601) 856-2460
Entity
Organization
Contact information
Practice address
12 PROFESSIONAL PKWY, RIDGELAND, MS 39157-4113
(601) 856-2460
(601) 856-4687
Mailing address
12 PROFESSIONAL PKWY, RIDGELAND, MS 39157-4113
(601) 856-2460
(601) 856-4687
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
11037
MS
305S00000X
Point of Service
11037
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00017026
—
MS
Enumeration date
06/11/2008
Last updated
06/11/2008
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