# TUPELO MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1396783916
- **Authorized official:** DR. JULIAN D. LODEN M.D. (VICE PRESIDENT)
- **Authorized official phone:** (662) 407-2528

## Contact information

- **Practice address:** 1265 CLIFF GOOKIN BOULEVARD, TUPELO, MS 38801-6749
- **Practice address phone:** (662) 840-2131
- **Practice address fax:** (662) 840-2522
- **Mailing address:** 1265 CLIFF GOOKIN BOULEVARD, TUPELO, MS 38801-6749
- **Mailing address phone:** (662) 407-2528
- **Mailing address fax:** (662) 620-9915

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/04/2006
- **Last updated:** 12/12/2011