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Organization

GRENADA ADULT HEALTHCARE CLINIC PC.

Active
Other names
Grenada Adult HealthCare Clinic PC.
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JUSTICE AARON GONDWE M.D. (PRESIDENT)
(662) 227-6450
Entity
Organization

Contact information

Practice address
965 J K AVENT DR, SUITE 106, GRENADA, MS 38901-5045
(662) 227-6450
(662) 227-6452
Mailing address
965 J K AVENT DR, SUITE 106, GRENADA, MS 38901-5045
(662) 227-6450
(662) 227-6452

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
20373
MS
261QP2300X
Primary Care Clinic/Center
Primary
20373
MS

Other

Enumeration date
08/28/2008
Last updated
08/29/2008
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