Organization
GRENADA LAKE MEDICAL CENTER
Active
Other names
Grenada Primary Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES L DENTON (CEO)
(662) 227-7000
Entity
Organization
Contact information
Practice address
965 AVENT DR STE 105, GRENADA, MS 38901-5045
(662) 227-7575
Mailing address
965 AVENT DR STE 105, GRENADA, MS 38901-5045
(662) 227-7575
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
11-245
MS
282N00000X
General Acute Care Hospital
11-245
MS
Other
Enumeration date
12/12/2007
Last updated
12/17/2007
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