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305 Highway 346 Ecru MS 38841-9772 | |
(662) 489-2669 | |
(662) 489-2670 |
Full Name | |
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Speciality | General Practice |
Location | 305 Highway 346, Ecru, Mississippi |
Authorized Official Name and Position | Jonathan Leizman (PRESIDENT) |
Authorized Official Contact | 2164799063 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | 305 Highway 346 Ecru MS 38841-9772 Ph: (662) 489-2669 |
NPI Number | 1194140368 |
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Provider Enumeration Date | 02/25/2014 |
Last Update Date | 10/13/2022 |
Identifier | Type | State | Issuer |
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1194140368 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (* (Not Available)) | Primary |