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Organization
VICKSBURG SPECIAL CARE CLINIC LLC
Active
Organization
VICKSBURG SPECIAL CARE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL CHAD BARRETT (OWNER/MEMBER)
(601) 529-9341
Entity
Organization
Contact information
Practice address
4077 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180-5580
(601) 638-8600
(601) 638-8661
Mailing address
4077 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180-5580
(601) 638-8600
(601) 638-8661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/29/2009
Last updated
10/29/2014
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