Organization
INTERVENTIONAL DIABETES CENTER LLC 2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE HAMPTON (OWNER)
(919) 223-8208
Entity
Organization
Contact information
Practice address
211 E 2ND ST FL 1, CLARKSDALE, MS 38614-4302
(901) 791-1711
Mailing address
211 E 2ND ST FL 1, CLARKSDALE, MS 38614-4302
(901) 791-1711
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
—
—
213E00000X
Podiatrist
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/05/2025
Last updated
06/02/2025
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