Organization
NEW VIALITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLENE GATSON (CREDENTIALING SPECIALIST)
(601) 454-4220
Entity
Organization
Contact information
Practice address
711 BROOKWAY BLVD STE A711, BROOKHAVEN, MS 39601-2639
(601) 265-2016
(601) 436-4054
Mailing address
711 BROOKWAY BLVD STE A711, BROOKHAVEN, MS 39601-2639
(601) 265-2016
(601) 436-4054
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
07/08/2022
Last updated
07/08/2022
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