Organization
CENTRAL MEDICAL CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON B DELASHMET M.D. (PRESIDENT)
(601) 352-7011
Entity
Organization
Contact information
Practice address
1190 N STATE ST, SUITE 201, JACKSON, MS 39202-2413
(601) 352-7011
(601) 352-3173
Mailing address
1190 N STATE ST, SUITE 201, JACKSON, MS 39202-2413
(601) 352-7011
(601) 352-3173
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04200767
—
MS
Enumeration date
12/12/2006
Last updated
12/14/2007
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