# BETHANY MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003900655
- **Authorized official:** MRS. CHARLINE BRANDON RN (ADMINISTRATOR)
- **Authorized official phone:** (662) 846-5032

## Contact information

- **Practice address:** 548 ROSEMARY ROAD, SUITE A, CLEVELAND, MS 38732-0358
- **Practice address phone:** (662) 846-5032
- **Practice address fax:** (662) 846-5034
- **Mailing address:** PO BOX 358, 548 ROSEMARY ROAD, CLEVELAND, MS 38732-0358
- **Mailing address phone:** (662) 846-5032
- **Mailing address fax:** (662) 846-5034

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 07/30/2009