Organization
GLENDORA CLINIC
Active
Parent organization
TUTWILER CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TUTWILER CLINIC
Authorized official
ANNE E BROOKS DO (MEDICAL DIRECTOR)
(662) 345-2334
Entity
Organization
Contact information
Practice address
44 WESTBROOKS AVE, GLENDORA, MS 38928
(662) 375-8878
Mailing address
PO BOX 189, CORNER OF GIBSON AND WESTBROOKS AVE, GLENDORA, MS 38928-0189
(662) 375-8878
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R767376
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014072
—
MS
Enumeration date
07/14/2008
Last updated
07/14/2008
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