# TKB MCC

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

## Provider details

- **NPI number:** 1710103031
- **Authorized official:** THOMAS BRASWELL MD (OWNER)
- **Authorized official phone:** (662) 226-2030

## Contact information

- **Practice address:** 990 J K AVENT DR, GRENADA, MS 38901-5002
- **Practice address phone:** (662) 226-2030
- **Practice address fax:** (662) 227-1236
- **Mailing address:** PO BOX 458, GRENADA, MS 38902-0458
- **Mailing address phone:** (662) 226-2030
- **Mailing address fax:** (662) 227-1236

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 06207726 | — | MS |