Desoto Primary Care Clinic, Pllc | |
6942 Autumn Oaks Dr Olive Branch MS 38654-9379 | |
(901) 517-9171 | |
Not Available |
Full Name | Desoto Primary Care Clinic, Pllc |
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Speciality | Family Medicine |
Location | 6942 Autumn Oaks Dr, Olive Branch, Mississippi |
Authorized Official Name and Position | Laju A. Kumar (SOLE OWNER) |
Authorized Official Contact | 9015179171 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Desoto Primary Care Clinic, Pllc 6942 Autumn Oaks Dr Olive Branch MS 38654-9379 Ph: (901) 517-9171 | Desoto Primary Care Clinic, Pllc 6942 Autumn Oaks Dr Olive Branch MS 38654-9379 Ph: (901) 517-9171 |
NPI Number | 1477643732 |
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Provider Enumeration Date | 10/14/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1477643732 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 18277 (Mississippi) | Primary |
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