Edward Grant Vick Sr., M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

11522 Issued in MS

Practice address

360 Red Eagle Cir
Ridgeland, MS 39157-9775

Phone

(601) 856-1451

NPI assigned

Jul 29, 2011

Last updated

Jul 29, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1311897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311897600000",
    "number": "1548548217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 RED EAGLE CIR",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391579775",
            "telephone_number": "601-856-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 RED EAGLE CIR",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391579775",
            "telephone_number": "601-856-1451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICK",
        "first_name": "EDWARD",
        "middle_name": "GRANT",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-29",
        "last_updated": "2011-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MS",
            "license": "11522",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TN",
            "license": "MD8764",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lana Denise Varnado, COTA-L
• Dylan Varner
• Jason William Vassar, D.M.D.
• Indira K Veerisetty, M.D.
• Brian Ernest Velez, MASSAGE THERAPIST
• Peyton Vickers
• Victoria L Carroll, Pmhnp-BC, LLC (Magnolia Psychiatry)
• Nathan Viera
• Lateshia McDade Vincent, OTR-L
• Virtue Standards LLC

• Otolaryngology Physician in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Otolaryngology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; 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.