Organization
DR. MILTON GARY WALDROP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRIS BURNSIDE JOURDAN (OFFICE MANAGER)
(662) 328-9123
Entity
Organization
Contact information
Practice address
116 LAWRENCE DR, SUITE 1, COLUMBUS, MS 39702-5319
(662) 328-9123
(662) 328-9152
Mailing address
116 LAWRENCE DR, SUITE 1, COLUMBUS, MS 39702-5319
(662) 328-9123
(662) 328-9152
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1024-61
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
425669694
SS#
MS
Enumeration date
06/04/2007
Last updated
07/01/2008
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