Full Name | |
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Speciality | Family Medicine |
Location | 1096 Beech St, Wesson, Mississippi |
Authorized Official Name and Position | Kortney M. Gaddy (CFO) |
Authorized Official Contact | 6015747200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
27190 Hwy 28 Hazlehurst MS 39083 Ph: (601) 574-7200 | 1096 Beech St Wesson MS 39191 Ph: (601) 894-2514 |
NPI Number | 1720650237 |
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Provider Enumeration Date | 07/14/2021 |
Last Update Date | 09/22/2022 |
Medicare PECOS PAC ID | 2062583487 |
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Medicare Enrollment ID | O20230405003100 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720650237 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |