Organization
WARRINGTON CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD EDWIN WALLER M.D. (VICE PRESIDENT)
(662) 326-3500
Entity
Organization
Contact information
Practice address
1022 MARTIN LUTHER KING DRIVE, POB 289, MARKS, MS 38646
(662) 326-3500
Mailing address
1022 MARTIN LUTHER KING DRIVE, POB 289, MARKS, MS 38646
(662) 326-3500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9011104
—
MS
Enumeration date
01/16/2007
Last updated
08/01/2011
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