# INTERNAL MEDICINE PRIMARY CARE PA

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

## Provider details

- **NPI number:** 1629542832
- **Authorized official:** IMAD TAHBOUB MD (OWNER)
- **Authorized official phone:** (601) 519-0509

## Contact information

- **Practice address:** 140 DAUGHDRILL STA, FLOWOOD, MS 39232-8406
- **Practice address phone:** (601) 519-0509
- **Mailing address:** 140 DAUGHDRILL STA, FLOWOOD, MS 39232-8406
- **Mailing address phone:** (601) 519-0509

## Taxonomy

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

## Other

- **Enumeration date:** 01/22/2019
- **Last updated:** 01/22/2019