Organization
CANTON FOOT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA F. THOMAS CNS (FNP)
(601) 672-7835
Entity
Organization
Contact information
Practice address
205 RIDGE PARK CV N, RAYMOND, MS 39154-9679
(601) 672-7835
(601) 346-7133
Mailing address
PO BOX 720894, BYRAM, MS 39272-0894
(601) 672-7835
(601) 346-7133
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R772161
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125897
—
MS
05
—
04587370
—
MS
01
—
C03380
MEDICARE GROUP
—
Enumeration date
11/28/2006
Last updated
10/16/2008
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