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303 Lamar Avenue Kilmichael MS 39747 | |
(662) 262-4284 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 303 Lamar Avenue, Kilmichael, Mississippi |
Authorized Official Name and Position | Calvin Dexter Johnson (ADMINISTRATOR) |
Authorized Official Contact | 6622624311 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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303 Lamar Avenue P.o. Box 186 Kilmichael MS 39747 Ph: (662) 262-4284 | 303 Lamar Avenue Kilmichael MS 39747 Ph: (662) 262-4284 |
NPI Number | 1144362054 |
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Provider Enumeration Date | 02/14/2007 |
Last Update Date | 05/13/2008 |
Identifier | Type | State | Issuer |
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1144362054 | NPI | - | NPPES |
02621525 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |