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Organization

FRIENDSHIP MEDICAL CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BOBBY KEN NOWLIN (OWNER)
(662) 489-3333
Entity
Organization

Contact information

Practice address
5129 HIGHWAY 15 N, ECRU, MS 38841-9407
(662) 488-8799
(772) 382-7966
Mailing address
5129 HIGHWAY 15 N, ECRU, MS 38841-9407
(662) 488-8799
(772) 382-7966

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
04170317
MS
Enumeration date
05/19/2006
Last updated
09/09/2011
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