Organization
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Active
Other names
South Central Dermatology Clinic - Waynesboro
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES T CANIZARO (VP OF FINANCE/CFO)
(601) 399-6139
Entity
Organization
Contact information
Practice address
920 MATTHEW DR, SUITE 8, WAYNESBORO, MS 39367-2553
(601) 425-7583
(601) 399-6281
Mailing address
PO BOX 1649, LAUREL, MS 39441-1649
(601) 425-7583
(601) 399-6281
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
09/17/2013
Last updated
09/17/2013
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