Organization
GRENADA LAKE INPATIENT MEDICINE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH HEARTSILL (CFO)
(662) 227-7172
Entity
Organization
Contact information
Practice address
960 J K AVENT DR, GRENADA, MS 38901-5230
(662) 227-7492
(662) 227-7541
Mailing address
PO BOX 52007, ATLANTA, GA 30355-0007
(678) 397-0060
(678) 397-0065
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
01/24/2007
Last updated
04/20/2008
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