# BOLIVAR PHYSICIAN PRACTICES LLC

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

## Provider details

- **NPI number:** 1043454655
- **Authorized official:** CHARLOTTE LAWRENCE (SECRETARY)
- **Authorized official phone:** (615) 920-7000

## Contact information

- **Practice address:** 810 E SUNFLOWER RD, STE. 100A, CLEVELAND, MS 38732-2800
- **Practice address phone:** (662) 843-8885
- **Practice address fax:** (662) 843-2280
- **Mailing address:** 810 E SUNFLOWER RD STE 100A, CLEVELAND, MS 38732-2828

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/27/2009
- **Last updated:** 06/04/2026