William Robert Justice Jr., M.D.
Individual provider Active NPI Pediatrics Physician · Meridian, MS
NPI 1124480033 · NPPES record last updated Nov 6, 2024
Key facts
- NPI
- 1124480033
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 25857 (MS)
- Practice address
- 1600 22ND Avenue
Medical Towers 3, Third Floor, Suite B
Meridian, MS 39301 - Phone
- (601) 703-8370
- Fax
- (601) 703-8397
- NPI assigned
- Mar 22, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241030001262 | MS | Practitioner - Pediatric Medicine | 5496040941 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25857 | MS | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anderson Regional Medical Center | Current | Accepting new patients | |
| Anderson Regional Medical Center | Current |
Accepting new patients | |
| Anderson Regional Medical Center | Current |
Accepting new patients | |
| Anderson Physician Alliance, Inc. | Past |
Accepting new patients | |
| Anderson Regional Medical Center | Past | Accepting new patients |
Locations
1102 Constitution Ave
Meridian, MS 39301
Phone (601) 693-2511
2124 14th St
Meridian, MS 39301
Phone (601) 483-8811
1600 22nd Ave
#3
Meridian, MS 39301
Phone (601) 693-1055
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25857 | MS | Yes |
Addresses
Primary practice location
1600 22ND Avenue
Medical Towers 3, Third Floor, Suite B
Meridian, MS 39301
Mailing address
PO Box 749215
Atlanta, GA 30374-9215
Phone (901) 226-3186
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07126570 | Medicaid | MS |
Other providers in Meridian, MS
- Scott B. Jordan
- Terry T Jordan
- Monique Joseph
- Hannah Stovall Joyner
- Juantina Johnson MD LLC
- Robert S Justus Sr.
- K&R Optical Solutions Corporation
- K&R Optical Solutions Corporation
- Barbara Kaderabek
- Daniel Kahn
All providers in Meridian, MS · Pediatrics Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.