| Diamond Grove Center | |
|
2311 Highway 15 S Louisville MS 39339-7071 | |
| (662) 779-0119 | |
| (662) 779-0126 |
| Full Name | Diamond Grove Center |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2311 Highway 15 S, Louisville, Mississippi |
| Authorized Official Name and Position | Brenda Smith (BUSINESS OFFICE DIRECTOR) |
| Authorized Official Contact | 6015819906 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Diamond Grove Center Po Box 848 Louisville MS 39339-0848 Ph: (662) 779-0119 | Diamond Grove Center 2311 Highway 15 S Louisville MS 39339-7071 Ph: (662) 779-0119 |
| NPI Number | 1770617086 |
|---|---|
| Provider Enumeration Date | 03/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770617086 | NPI | - | NPPES |
| 00220411 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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