Organization
DRG FAYETTE, PLLC
Active
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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