Organization
PHYSICIANS AND SURGEONS
Active
Other names
Grenada Doctors Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY JONES (OFFICE MANAGER)
(662) 226-2021
Entity
Organization
Contact information
Practice address
1732 COMMERCE ST, GRENADA, MS 38901-4615
(662) 226-2021
(662) 226-1516
Mailing address
1732 COMMERCE ST, GRENADA, MS 38901-4615
(662) 226-2021
(662) 226-1516
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014089
—
MS
01
—
253915
RIVERBEND
MS
Enumeration date
07/29/2006
Last updated
07/21/2022
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