Individual
DR. EDWARD GRANT VICK SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
360 RED EAGLE CIR, RIDGELAND, MS 39157-9775
(601) 856-1451
Mailing address
360 RED EAGLE CIR, RIDGELAND, MS 39157-9775
(601) 856-1451
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
11522
MS
207Y00000X
Otolaryngology Physician
MD8764
TN
Other
Enumeration date
07/29/2011
Last updated
07/29/2011
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