Organization
THE GREENVILLE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA E SPRATLIN (ADMINISTRATOR)
(662) 379-8104
Entity
Organization
Contact information
Practice address
1502 S COLORADO ST, GREENVILLE, MS 38703-7219
(662) 332-9872
(662) 332-9878
Mailing address
1502 S COLORADO ST, GREENVILLE, MS 38703-7219
(662) 332-9872
(662) 332-9878
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
246XC2903X
Vascular Specialist/Technologist Cardiovascular
—
—
2471B0102X
Bone Densitometry Radiologic Technologist
—
—
2471C3401X
Computed Tomography Radiologic Technologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2500316731
CLIA
MS
05
—
9014413
—
MS
01
—
CD3504
RAILROAD MEDICARE
MS
Enumeration date
06/29/2006
Last updated
03/02/2026
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