Individual
MARTHA D DICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1190 N STATE ST, SUITE 201, JACKSON, MS 39202-2413
(601) 973-1624
(601) 973-1596
Mailing address
1190 N STATE ST, SUITE 201, JACKSON, MS 39202-2413
(601) 973-1624
(601) 973-1596
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10686
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
753068151
MS HEALTH PARTNERS
MS
Enumeration date
03/16/2006
Last updated
03/16/2010
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