Greater Jackson OBGYN LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

GREATER JACKSON OBGYN LLC

Practice address

501 Marshall St Ste 502
Jackson, MS 39202-1661

Phone

(769) 233-8585

Fax

(601) 487-5156

NPI assigned

Mar 10, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debra Amy Martin

Title

Office Manager

Phone

(769) 233-8585

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Metro Jackson OBGYN Doing business as

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1154956134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST STE 502",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021661",
            "telephone_number": "769-233-8585",
            "fax_number": "601-487-5153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST STE 502",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021661",
            "telephone_number": "769-233-8585",
            "fax_number": "601-487-5156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER JACKSON OBGYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-10",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "AMY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "769-233-8585"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00118723",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Sevocity",
            "affiliation": "N",
            "endpointDescription": "EMR and PM",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "501 Marshall St Ste 502",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392021661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Metro Jackson OBGYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rashaad Gray
• Rica Miller Gray, LPC, NCC, CRC
• Sandra Gray, RDH
• Tracey Grayer, NURSE PRACTITIONER
• Destiny Grear
• Greater Jackson Physician Group
• Green Behavioral Services, LLC
• Green Case Management Services
• Amy Green
• Anthony Green

• Obstetrics & Gynecology Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Obstetrics & Gynecology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.