# NORTHEAST MS INTERNAL MEDICINE PC

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

## Provider details

- **NPI number:** 1407831928
- **Authorized official:** MR. LAURENCE L DENNIS MD (PRESIDENT)
- **Authorized official phone:** (662) 340-1138

## Contact information

- **Practice address:** 202 N 1ST ST, SUITE A, BOONEVILLE, MS 38829-2718
- **Practice address phone:** (662) 340-1138
- **Practice address fax:** (662) 728-5185
- **Mailing address:** 202 N 1ST ST, SUITE A, BOONEVILLE, MS 38829-2718
- **Mailing address phone:** (662) 340-1138
- **Mailing address fax:** (662) 728-5185

## Taxonomy

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

## Other

- **Enumeration date:** 12/07/2005
- **Last updated:** 06/30/2015