Organization
MID DELTA RADIOLOGY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEY OLIVER (MANAGER)
(662) 832-3514
Entity
Organization
Contact information
Practice address
130 RIVER CLUB CIR, CLARKSDALE, MS 38614-9725
(662) 832-3514
(866) 782-0773
Mailing address
130 RIVER CLUB CIR, CLARKSDALE, MS 38614-9725
(662) 832-3514
(866) 782-0773
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
E7789
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209761002
—
AR
Enumeration date
09/11/2012
Last updated
07/05/2023
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