| The Premier Center Llc | |
|
983 S Line St Grenada MS 38901-3723 | |
| (662) 809-3794 | |
| (662) 226-3794 |
| Full Name | The Premier Center Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 983 S Line St, Grenada, Mississippi |
| Authorized Official Name and Position | Mamie Elizabeth Swims (OWNER) |
| Authorized Official Contact | 6628093794 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Premier Center Llc 983 S Line St Grenada MS 38901-3723 Ph: (662) 809-3794 | The Premier Center Llc 983 S Line St Grenada MS 38901-3723 Ph: (662) 809-3794 |
| NPI Number | 1265839666 |
|---|---|
| Provider Enumeration Date | 12/01/2014 |
| Last Update Date | 12/01/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265839666 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C6400 (Mississippi) | Primary |
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