Organization
GERIATRIC SPECIALTIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DON KING RN (SOLE MEMBER)
(662) 983-0139
Entity
Organization
Contact information
Practice address
188 W OXFORD ST, PONTOTOC, MS 38863-2006
(662) 983-0139
Mailing address
PO BOX 1035, PONTOTOC, MS 38863-1035
(662) 983-0739
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R654388
MS
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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