Organization
GRENADA LAKE MEDICAL CENTER
Active
Other names
Grenada Women's Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHELLEY SMITH CFNP (CLINICAL DIRECTOR)
(662) 226-5121
Entity
Organization
Contact information
Practice address
1900 GRANDVIEW DR, GRENADA, MS 38901-5066
(662) 226-5121
(662) 226-7529
Mailing address
1900 GRANDVIEW DR, GRENADA, MS 38901-5066
(662) 226-5121
(662) 226-7529
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07436578
—
MS
Enumeration date
09/15/2006
Last updated
04/03/2012
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