# GOOD SHEPHERD MEDICAL/DENTAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Good Shepherd Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770158339
- **Authorized official:** MR. DAVID WOLGAMOTT (OFFICE MANAGER)
- **Authorized official phone:** (601) 426-2001

## Contact information

- **Practice address:** 207 S 11TH AVE, LAUREL, MS 39440-4314
- **Practice address phone:** (601) 426-2001
- **Practice address fax:** (601) 426-2002
- **Mailing address:** PO BOX 2704, LAUREL, MS 39442-2704
- **Mailing address phone:** (601) 426-2001
- **Mailing address fax:** (601) 426-2002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336S0011X | Specialty Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/25/2021
- **Last updated:** 05/25/2021