Organization
MID SOUTH MED, LLC
Active
Other names
Wellness Walk-In Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLIVER BANKS (OFFICE MANAGER)
(901) 497-1040
Entity
Organization
Contact information
Practice address
9160 HIGHWAY 64, SUITE 5, LAKELAND, TN 38002-4766
(901) 623-3587
(901) 213-9235
Mailing address
9160 HIGHWAY 64, SUITE 5, LAKELAND, TN 38002-4766
(901) 623-3587
(901) 213-9235
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD0000006816
TN
Other
Enumeration date
10/26/2016
Last updated
10/26/2016
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