Organization
CLINTON WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRICIA B DUNCAN BILLER (MEDICAL BILLER)
(601) 878-6945
Entity
Organization
Contact information
Practice address
703 HIGHWAY 80 W STE A, CLINTON, MS 39056-4107
(601) 488-6187
(601) 878-2011
Mailing address
PO BOX 1338, CLINTON, MS 39060-1338
(601) 488-6187
(601) 878-2011
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18239
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07033864
—
MS
01
—
587159423I
BCBS
MS
Enumeration date
12/03/2007
Last updated
01/02/2009
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