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Organization
NORTH DELTA MEDICINE CLINIC P A
Active
Organization
NORTH DELTA MEDICINE CLINIC P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH WAYNE KELLOUGH M.D. (OWNER)
(662) 621-2192
Entity
Organization
Contact information
Practice address
705 N STATE ST, CLARKSDALE, MS 38614-6519
(662) 621-2192
(662) 621-2314
Mailing address
PO BOX 1930, CLARKSDALE, MS 38614-7930
(662) 621-2192
(662) 621-2314
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16776
MS
Other
Enumeration date
10/03/2006
Last updated
12/03/2009
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