# GRAYSON CREEK MEDICAL CLINIC, LLC

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

## Provider details

- **NPI number:** 1184166035
- **Authorized official:** MACK E KNIGHT FNP-C (OWNER)
- **Authorized official phone:** (601) 408-9945

## Contact information

- **Practice address:** 3 JOHN EVERETT RD, MOSELLE, MS 39459-9771
- **Practice address phone:** (601) 620-9991
- **Mailing address:** 3 JOHN EVERETT RD, MOSELLE, MS 39459-9771
- **Mailing address phone:** (601) 620-9991

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | 732001 | MS | — |
| 363LF0000X | Family Nurse Practitioner | 901749 | MS | — |
| 363LP0200X | Pediatric Nurse Practitioner | 732001 | MS | Yes |

## Other

- **Enumeration date:** 11/09/2016
- **Last updated:** 10/19/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0044232 | — | MS |