Organization
WINSTON MEDICAL CLINIC FAIR ELEMENTARY SCHOOL
Active
Parent organization
WINSTON MEDICAL CLINIC LLC
Other names
Winston Medical Clinic LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WINSTON MEDICAL CLINIC LLC
Authorized official
DEBRA J FRYERY (DIRECTOR OF CLINIC OPERATIONS)
(662) 446-1972
Entity
Organization
Contact information
Practice address
301 N COLUMBUS AVE, LOUISVILLE, MS 39339-2315
(662) 446-1972
(662) 446-1039
Mailing address
PO BOX 470, LOUISVILLE, MS 39339-0470
(662) 446-1972
(552) 446-1039
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R860217
MS
Other
Enumeration date
01/12/2016
Last updated
01/12/2016
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