Organization
GRAYSON CREEK MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACK E KNIGHT FNP-C (OWNER)
(601) 408-9945
Entity
Organization
Contact information
Practice address
3 JOHN EVERETT RD, MOSELLE, MS 39459-9771
(601) 620-9991
Mailing address
3 JOHN EVERETT RD, MOSELLE, MS 39459-9771
(601) 620-9991
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
732001
MS
363LF0000X
Family Nurse Practitioner
901749
MS
363LP0200X
Pediatric Nurse Practitioner
Primary
732001
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0044232
—
MS
Enumeration date
11/09/2016
Last updated
10/19/2017
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