Organization
GOLDEN AGE INC
Active
Other names
Golden Age Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TABATHA DANIELLE WATKINS (ADMINISTRATOR)
(662) 453-6323
Entity
Organization
Contact information
Practice address
2901 HIGHWAY 82 E, GREENWOOD, MS 38930-2960
(662) 374-2185
(662) 374-2195
Mailing address
2901 HIGHWAY 82 EAST, GREENWOOD, MS 38930-2960
(662) 374-2185
(662) 374-2195
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09705072
—
MS
Enumeration date
02/01/2010
Last updated
01/06/2022
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