Organization
NW MISSISSIPPI SPECIALTY CLINIC
Active
Other names
Southern Healthcare Providers PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODERICK GIVENS MD (PRESIDENT)
(770) 443-4483
Entity
Organization
Contact information
Practice address
1401 RIVER RD, GREENWOOD, MS 38930-4030
(888) 670-6080
(770) 443-4410
Mailing address
PO BOX 18394, NATCHEZ, MS 39122-8394
(888) 670-6080
(770) 443-4410
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
14914
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117509
—
MS
Enumeration date
07/15/2008
Last updated
07/15/2008
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