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301 Lamar Ave. Kilmichael MS 39747-0188 | |
(662) 262-4311 | |
(662) 262-5586 |
Full Name | |
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Speciality | Radiology - Diagnostic Radiology |
Location | 301 Lamar Ave., 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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Po Box 188 Kilmichael MS 39747-0188 Ph: (662) 262-4311 | 301 Lamar Ave. Kilmichael MS 39747-0188 Ph: (662) 262-4311 |
NPI Number | 1518176445 |
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Provider Enumeration Date | 05/21/2007 |
Last Update Date | 05/17/2011 |
Identifier | Type | State | Issuer |
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1518176445 | NPI | - | NPPES |
03335377 | Medicaid | MS | |
19147 | Other | MS | PROFESSIONAL COMPONENT |