Organization
DELTA NEUROLOGY CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. M FASEEH HADIDI MD (OWNER)
(662) 627-2544
Entity
Organization
Contact information
Practice address
785 OHIO AVE, SUITE 2C, CLARKSDALE, MS 38614-6217
(662) 627-2544
(662) 627-2052
Mailing address
785 OHIO AVE, SUITE 2C, CLARKSDALE, MS 38614-6217
(662) 627-2544
(662) 627-2052
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
17427
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124811
—
MS
05
—
154530001
—
AR
Enumeration date
09/16/2008
Last updated
01/06/2014
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