Organization
MISSISSIPPI ASTHMA AND ALLERGY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID L MOAK (PRACTICE ADMINISTRATOR)
(601) 354-4836
Entity
Organization
Contact information
Practice address
1400 20TH AVE, SUITE C, MERIDIAN, MS 39301
(601) 693-0217
(601) 535-6884
Mailing address
1513 LAKELAND DR, SUITE 101, JACKSON, MS 39216-4829
(601) 354-4836
(601) 354-2619
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
Other
Enumeration date
07/10/2007
Last updated
02/16/2010
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