# D'IBERVILLE MEDICAL CLINIC LLC

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

## Provider details

- **NPI number:** 1629536925
- **Authorized official:** MR. JERRY R ADKINS (ADMINISTRATOR)
- **Authorized official phone:** (228) 861-6049

## Contact information

- **Practice address:** 11516 LAMEY BRIDGE RD, STE 1, DIBERVILLE, MS 39540-2725
- **Practice address phone:** (228) 207-4190
- **Practice address fax:** (228) 207-4190
- **Mailing address:** PO BOX 1277, BILOXI, MS 39533-1277
- **Mailing address phone:** (228) 207-4190
- **Mailing address fax:** (228) 207-4156

## Taxonomy

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

## Other

- **Enumeration date:** 03/05/2019
- **Last updated:** 05/02/2019