Organization
GOUGH'S FAMILY AND PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER GOUGH M. D. (OWNER/PHYSICIAN)
(662) 745-6638
Entity
Organization
Contact information
Practice address
189 N MAIN ST, DREW, MS 38737-3146
(662) 745-6638
(662) 745-8480
Mailing address
PO BOX 68, DREW, MS 38737-0068
(662) 745-6638
(662) 745-8480
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
06639
MS
Other
Enumeration date
01/30/2013
Last updated
01/30/2013
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