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Organization
STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Active
Organization
STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Active
Parent organization
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Other names
UNIVERSITY OF MISSISSIPPI MEDICAL CENTER-GRENADA SPECIALTY CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Authorized official
MR. KEVIN COOK (CEO)
(601) 984-4113
Entity
Organization
Contact information
Practice address
965 AVENT DR, SUITE 100A, GRENADA, MS 38901-5045
(662) 227-7444
(662) 227-7443
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-4113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/05/2013
Last updated
03/06/2014
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