# VICKSBURG SPECIAL CARE CLINIC LLC

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

## Provider details

- **NPI number:** 1487988002
- **Authorized official:** MITCHELL CHAD BARRETT (OWNER/MEMBER)
- **Authorized official phone:** (601) 529-9341

## Contact information

- **Practice address:** 4077 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180-5580
- **Practice address phone:** (601) 638-8600
- **Practice address fax:** (601) 638-8661
- **Mailing address:** 4077 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180-5580
- **Mailing address phone:** (601) 638-8600
- **Mailing address fax:** (601) 638-8661

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/29/2009
- **Last updated:** 10/29/2014