| South Central Reg Med Ctr-mnt | |
|
1220 Jefferson St, Laurel, MS 39440-4355 | |
| (601) 426-4000 | |
| (601) 399-6254 |
| Full Name | South Central Reg Med Ctr-mnt |
|---|---|
| Type | Facility |
| Speciality | Dietitian, Registered |
| Location | 1220 Jefferson St, Laurel, Mississippi |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649329475 | NPI | - | NPPES |
| 08759070 | Medicaid | MS | |
| 512G700476 | Other | MS | MEDICARE PTAN |
| 000019141 | Other | MS | BLUE CROSS OF MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133V00000X | Dietitian, Registered | 11-153 (Mississippi) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| South Central Reg Med Ctr-mnt Po Box 607, Laurel, MS 39441-0607 Ph: (601) 426-4000 | South Central Reg Med Ctr-mnt 1220 Jefferson St, Laurel, MS 39440-4355 Ph: (601) 426-4000 |
Ms. Martha Laurie Watts, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 117 S 11th Ave, Laurel, MS 39440 Phone: 601-425-3033 Fax: 601-422-0431 | |
Glenda Z Mccraw, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1220 Jefferson St, Laurel, MS 39440 Phone: 601-426-4083 Fax: 601-426-4417 | |
Ms. Gayla B. Glenn, R.D. Dietitian Medicare: Not Enrolled in Medicare Practice Location: 117 S 11th Ave, Laurel, MS 39440 Phone: 601-425-3033 Fax: 601-422-0431 | |
Mrs. Bonita Nicole Jaynes, M.S., R.D. Dietitian Medicare: Not Enrolled in Medicare Practice Location: 117 South 11th Avenue, Laurel, MS 39440 Phone: 601-425-3033 Fax: 601-422-0431 | |
Gina H Mixon, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1220 Jefferson St, Laurel, MS 39440 Phone: 601-426-4086 Fax: 601-426-4417 |