# THE CLARKDALE CLINIC, LLC

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

## Provider details

- **NPI number:** 1790284693
- **Authorized official:** WANDA PIERCE (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (601) 781-8677

## Contact information

- **Practice address:** 6905 HIGHWAY 145 S, MERIDIAN, MS 39301-9771
- **Practice address phone:** (601) 696-6736
- **Practice address fax:** (601) 696-6778
- **Mailing address:** 4715 24TH PL, MERIDIAN, MS 39305-1686
- **Mailing address phone:** (601) 696-6736
- **Mailing address fax:** (601) 696-6778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/06/2018
- **Last updated:** 02/06/2018