Individual
CHARLES GROGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5607
(601) 984-6665
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5607
(601) 984-6665
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/04/2017
Last updated
04/04/2017
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