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Organization

WOODLAND CLINIC LLC

Active
Other names
WOODLAND CLINIC LLC
Organization subpart
No

Provider details

NPI number
Authorized official
JERRY SULLIVAN (OWNER)
(662) 456-0111
Entity
Organization

Contact information

Practice address
120 MARKET ST, WOODLAND, MS 39776-9104
(662) 456-0111
(662) 456-7335
Mailing address
PO BOX 186, WOODLAND, MS 39776-0186
(662) 456-0111
(662) 456-7335

Taxonomy

Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0112415
MS
05
0114346
MS
05
09014809
MS
Enumeration date
05/10/2007
Last updated
01/29/2011
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