Organization
NORTH CENTRAL MISSISSIPPI REGIONAL CANCER CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MADISON WILSON GAILLARD III (ADMINISTRATOR)
(662) 459-7133
Entity
Organization
Contact information
Practice address
1401 RIVER RD, GREENWOOD, MS 38930-4030
(662) 459-7133
(662) 459-7136
Mailing address
1401 RIVER RD, GREENWOOD, MS 38930-4030
(662) 459-7133
(662) 459-7136
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
07161
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9014280
—
MS
Enumeration date
08/31/2006
Last updated
08/22/2020
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