Organization
THE CHILDREN'S MEDICAL GROUP
Active
Parent organization
THE CHILDREN'S MEDICAL GROUP OF GREENVILLE PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE CHILDREN'S MEDICAL GROUP OF GREENVILLE PLLC
Authorized official
DR. HOSAN MENANYA AZOMANI MD (MANAGER)
(662) 334-9915
Entity
Organization
Contact information
Practice address
1421 E PEACE ST, CANTON, MS 39046-4938
(601) 859-5955
Mailing address
PO BOX 1735, GREENVILLE, MS 38702-1735
(662) 334-9915
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
18728
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02933236
—
MS
Enumeration date
06/05/2008
Last updated
06/05/2008
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