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110 Park St Walnut Grove MS 39189-6526 | |
(601) 253-0173 | |
(601) 253-0176 |
Full Name | |
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Speciality | Family Medicine |
Location | 110 Park St, Walnut Grove, Mississippi |
Authorized Official Name and Position | Cheryl L Savell (PROVIDER ENROLLMENT) |
Authorized Official Contact | 6013891563 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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110 Park St Walnut Grove MS 39189-6526 Ph: (601) 253-0173 | 110 Park St Walnut Grove MS 39189-6526 Ph: (601) 253-0173 |
NPI Number | 1255650321 |
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Provider Enumeration Date | 05/27/2010 |
Last Update Date | 01/07/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255650321 | NPI | - | NPPES |
1033196977 | Other | MS | DR'S NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 12146 (Mississippi) | Primary |