Organization
GREENWOOD COMPREHENSIVE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VALENCIA PATRICE MARTIN M.D. (VICE PRESIDENT)
(662) 455-6767
Entity
Organization
Contact information
Practice address
517 HIGHWAY 82 W, GREENWOOD, MS 38930-5030
(662) 455-6767
(662) 455-1774
Mailing address
PO BOX 1179, GREENWOOD, MS 38935-1179
(662) 455-6767
(662) 455-1774
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10298
MS
207R00000X
Internal Medicine Physician
10035
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000016353
—
MS
05
—
00016353
—
MS
05
—
006785238
—
MS
05
—
009015021
—
MS
05
—
06785238
—
MS
05
—
09015021
—
MS
Enumeration date
02/19/2007
Last updated
05/22/2024
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