MS. DEDRI MARKITA IVORY (NPI# 1851585004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851585004 |
| Entity Type | Individual |
| Full Name | MS. DEDRI MARKITA IVORY |
| Credential | M.D. |
| Practice Address |
3510 Pemberton Square Blvd Vicksburg MS 39180-5506 |
| Practice Telephone | 6015016991 |
| Practice Fax Number | 6015016987 |
| Mailing Telephone | 6015016991 |
| Mailing Fax Number | 6015016987 |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2017-01-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
21520 | MS | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 57.011968 | OH | Student, Health Care |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 2009009253 | MO | Student, Health Care |
| Street Address |
3510 PEMBERTON SQUARE BLVD |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-5506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508229378 | River City Medical and Arthritis Center LLC | Internal Medicine | 3510 Pemberton Square Blvd, Vicksburg, MS 39180-5506 | 2016-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255877346 | Elite Performance and Rehab, LLC | Clinic/Center | 1901 A Mission 66, Vicksburg, MS 39180 | 2017-01-12 |
| 1679931083 | Heather M Anderson | Physician Assistant | 2080 S Frontage Rd Ste 100, Vicksburg, MS 39180 | 2016-02-01 |
| 1245604941 | Warren County Assn.for Retarded Citizens, Inc. | Day Training, Developmentally Disabled Services | 100 Smokey Lane, Vicksburg, MS 39180 | 2015-11-18 |
| 1386012904 | Brian Oliver Snowden | Counselor | 3530 Manor Dr Ste 5a, Vicksburg, MS 39180 | 2015-09-14 |
| 1962802710 | Jordan P. Crocker, D.m.d., Pllc | Clinic/Center | 109 Monument Place, Vicksburg, MS 39180 | 2014-08-29 |
| 1821434259 | Trisha Addison | Physical Therapist | 2222 South Frontage Road, Suite D, Vicksburg, MS 39180 | 2013-05-13 |
| 1073862157 | Laura Jeanne Briggs | Physical Therapist | 1901-a Mission 66, Vicksburg, MS 39180 | 2012-09-05 |
| 1912175258 | Andrea T. Harris | Counselor | Warren-yazoo Mental Health Service, 3444 Wisconsin Ave., Vicksburg, MS 39180 | 2008-02-20 |
| 1922217314 | Austin Family Dentistry | Dentist | 3040 Indiana Ave, Vicksburg, MS 39180 | 2007-05-22 |
| 1063539138 | Ollie Hardaway Jr. | Dentist | 154 Cottonwood Street, Vicksburg, MS 39180 | 2007-03-23 |
| Find all providers in zip 39180 | ||||
| Taxonomy Code | 207RR0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Rheumatology |
| An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508229378 | River City Medical and Arthritis Center LLC | Internal Medicine | 3510 Pemberton Square Blvd, Vicksburg, MS 39180-5506 | 2016-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740835305 | North Mississippi Medical Center, Inc. | Internal Medicine | 408 Council Cir Ste A, Tupelo, MS 38801-4949 | 2019-08-09 |
| 1619356722 | Lauren Parker Hayward | Internal Medicine | 504 Azalea Dr Ste 4, Oxford, MS 38655-5397 | 2015-05-21 |
| 1649686395 | Madison Medical Rheumatology, LLC | Internal Medicine | 1607 Doctor's Drive, Madison, MS 39110-8671 | 2014-07-02 |
| 1952745663 | Neal Shparago Do Pa | Internal Medicine | 1190 N State St Ste 302, Jackson, MS 39202-2413 | 2013-04-24 |
| 1124247341 | Matthew Bernard Carroll | Internal Medicine | 3101 Denny Ave Ste 240, Pascagoula, MS 39581-5307 | 2007-04-25 |
| 1851431159 | David Ian Weiss | Internal Medicine | 15 Orleans Dr, Hattiesburg, MS 39402 | 2007-02-07 |
| 1487747234 | Rheumatology Associates, Pllc | Internal Medicine | 1190 N State St Ste 303, Jackson, MS 39202-2413 | 2006-10-02 |
| 1760495071 | Jean Guyton Gispen | Internal Medicine | Employee Health Service, V. B. Harrison Building, Rebel Drive, University, MS 38677 | 2006-08-15 |
| 1720092547 | Chris H Benson | Internal Medicine | 104 Millsaps Dr, Hattiesburg, MS 39402-1328 | 2006-07-28 |
| 1568499531 | Kenneth J. Hardy | Internal Medicine | 2550 Flowood Dr Ste 300, Flowood, MS 39232-9306 | 2006-06-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.