Active NPI
Fred Blackledge, M.D.
- Plastic Surgery Physician
- Jackson, MS
National Provider Identifier
1003890179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 16006
- Practice address
- 764 Lakeland Dr
Jackson, MS 39216-4617 - Phone
- (601) 981-3033
- Fax
- (601) 982-8132
- NPI assigned
- Dec 2, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 16006 | MS | Primary |
Addresses
Primary practice location
764 Lakeland Dr
Jackson, MS 39216-4617
Mailing address
PO Box 24023
Jackson, MS 39225-4023
Phone (601) 366-1400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16006 | MS | MD | Plastic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Faces PLLC | Plastic Surgery | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Plastic Surgery Physician
- Ridgeland, MS
- NPI 1053395111
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1003890179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 24023",
"city": "JACKSON",
"state": "MS",
"postal_code": "392254023",
"telephone_number": "601-366-1400",
"fax_number": "601-366-8167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "764 LAKELAND DR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164617",
"telephone_number": "601-981-3033",
"fax_number": "601-982-8132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKLEDGE",
"first_name": "FRED",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-02",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "MS",
"license": "16006",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.