Active NPI
Gloria Mangum Perry, M.D.
- Family Medicine Physician
- Brandon, MS
National Provider Identifier
1699986752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 12665
- Practice address
- 107 Bridlewood Dr
Brandon, MS 39047-8302 - Phone
- (601) 359-5155
- Fax
- (601) 359-5725
- NPI assigned
- May 24, 2007
- Last updated
- Nov 5, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 12665 | MS | Primary |
Addresses
Primary practice location
107 Bridlewood Dr
Brandon, MS 39047-8302
Mailing address
107 Bridlewood Dr
Brandon, MS 39047-8302
Phone (601) 992-7168
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00017860 | Medicaid | MS |
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 |
|---|---|---|---|
| 12665 | MS | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Family Medicine Associates, PLLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinic/Center
- Jackson, MS
- NPI 1396846648
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446681600000",
"number": "1699986752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 BRIDLEWOOD DR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390478302",
"telephone_number": "601-992-7168",
"fax_number": "601-992-2352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 BRIDLEWOOD DR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390478302",
"telephone_number": "601-359-5155",
"fax_number": "601-359-5725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRY",
"first_name": "GLORIA",
"middle_name": "MANGUM",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2015-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MS",
"license": "12665",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00017860",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brandon, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.