Organization
DRG FAYETTE, PLLC
Active
Other names
Diversified Renal Group Home Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TUNDE OLUTADE M.D. (OWNER)
(601) 899-3340
Entity
Organization
Contact information
Practice address
1005 MAIN STREET, FAYETTE, MS 39069
(601) 488-1070
(601) 899-3343
Mailing address
5903 RIDGEWOOD RD, SUITE 340, JACKSON, MS 39211-3700
(601) 488-1070
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
MS
Other
Enumeration date
11/02/2011
Last updated
11/14/2011
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