NPIMap

Organization Active NPI

Wesley Dee Granger, M.D., P.a.

  • Preferred Provider Organization
  • Ridgeland, MS
National Provider Identifier
1285894378
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
11037 Issued in MS
Legal business name
WESLEY DEE GRANGER, M.D., P.A.
Practice address
12 Professional Pkwy
Ridgeland, MS 39157-4113
Phone
(601) 856-2460
Fax
(601) 856-4687
NPI assigned
Jun 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Wesley Dee Granger, M.D.
Title
Owner
Phone
(601) 856-2460

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 11037 MS Primary
Point of Service 305S00000X 11037 MS

Addresses

Primary practice location

12 Professional Pkwy
Ridgeland, MS 39157-4113

Mailing address

12 Professional Pkwy
Ridgeland, MS 39157-4113
Phone (601) 856-2460

Other identifiers 1

IdentifierTypeStateIssuer
00017026MedicaidMS

Other names 1

  • Madison-Ridgeland Medical Clinic Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1285894378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 PROFESSIONAL PKWY",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574113",
            "telephone_number": "601-856-2460",
            "fax_number": "601-856-4687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 PROFESSIONAL PKWY",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574113",
            "telephone_number": "601-856-2460",
            "fax_number": "601-856-4687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESLEY DEE GRANGER, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-11",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "GRANGER",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-856-2460",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MS",
            "license": "11037",
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "MS",
            "license": "11037",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00017026",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison-Ridgeland Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ridgeland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.