Organization
RUTH K. FREDERICKS, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUTH KELLUM FREDERICKS M.D. (OWNER)
(601) 939-0361
Entity
Organization
Contact information
Practice address
971 LAKELAND DR, SUITE 557, WEST TOWER, JACKSON, MS 39216-4643
(601) 326-4602
(601) 326-4632
Mailing address
PO BOX 22670, JACKSON, MS 39225-2670
(601) 939-0361
(601) 939-5210
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
11722
MS
Other
Enumeration date
05/08/2006
Last updated
03/15/2013
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