Provider Demographics
NPI:1366438772
Name:BALTHROP, ERICA R (MD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:R
Last Name:BALTHROP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:901-226-3186
Mailing Address - Fax:901-226-3160
Practice Address - Street 1:401 SOUTHCREST CIR STE 104
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6712
Practice Address - Country:US
Practice Address - Phone:662-349-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16812207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS149982001OtherARK MEDICAID
MS82606OtherARK BC BS
MS00122260Medicaid
MS00122260Medicaid
MS149982001OtherARK MEDICAID