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Organization
CLEVELAND MEDICAL CLINIC PLLC
Active
Organization
CLEVELAND MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TOMMICILE DEAN ROGERS (ADMINISTRATOR)
(662) 843-3606
Entity
Organization
Contact information
Practice address
810 E SUNFLOWER RD, SUITE 100A, CLEVELAND, MS 38732-2800
(662) 843-3606
(662) 846-1194
Mailing address
PO BOX 1629, CLEVELAND, MS 38732-1629
(662) 843-3606
(662) 846-1194
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
04/24/2007
Last updated
02/05/2008
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