Full Name | |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 6543 Ms-15, Ecru, Mississippi |
Authorized Official Name and Position | Jody Addair (CLINICAL OPS PROJECT COORDINATOR) |
Authorized Official Contact | 3175560017 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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124 Allawood Ct Simpsonville SC 29681-6207 Ph: (864) 501-0751 | 6543 Ms-15 Ecru MS 38841 Ph: (662) 489-2669 |
NPI Number | 1740042563 |
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Provider Enumeration Date | 01/26/2024 |
Last Update Date | 01/27/2025 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740042563 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |