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602 N. Jefferson St. Macon MS 39341 | |
(662) 726-5831 | |
(662) 726-4638 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 602 N. Jefferson St., Macon, Mississippi |
Authorized Official Name and Position | Ernest Roy Stuart (PRESIDENT) |
Authorized Official Contact | 6627265831 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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602 N. Jefferson St. P.o. Box 306 Macon MS 39341 Ph: (662) 726-5831 | 602 N. Jefferson St. Macon MS 39341 Ph: (662) 726-5831 |
NPI Number | 1093880874 |
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Provider Enumeration Date | 11/21/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1093880874 | NPI | - | NPPES |
09014931 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 258944 (Mississippi) | Primary |
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